OBJECTIVES

Independent economic evaluations of bio-pharmaceutical products from US-based ICER group have gained considerable importance in health care financing decisions across payers. We evaluated the impact of UK’s NICE evaluations on ICER decisions and vice-versa to understand cross-border impact of economic assessments.

METHODS

We reviewed all ICER decisions communicated publicly during 2018 and extracted the NICE evaluation of the same set of bio-pharmaceutical products. We evaluated the sequence of such decisions (before-after ICER) and reviewed the cost-effectiveness assessments by the respective authorities.

RESULTS

All 20 ICER-reviewed products during 2018 was also reviewed and recommended by NICE. Thirteen of these products were reviewed by NICE first, while the guidance for the rest was communicated by ICER first. While the pricing mechanism cannot be directly compared, but guidance on usage was more restricted by NICE. Most innovative therapies (like, CAR-T) were exclusively recommended for special funding coverage (such as, Cancer Drug Fund) in UK. Most NICE recommended prices fell within the ICER recommended discounts to reach different QALY thresholds. Ongoing analyses will also highlight the level of utilization restrictions and impact on decision making sequence.

CONCLUSIONS

QALY-based pricing recommendations by ICER are playing a critical role in health care financing decisions by US payers. Manufacturers should monitor the sequence of evaluations as well as pricing recommendations to allow for robust strategy for reimbursement submissions across US and UK.