OBJECTIVES: A previous review of 10 completed National Institute for Health and Care Excellence (NICE) technology appraisals (TAs) of one immune checkpoint inhibitor (ICI), nivolumab, revealed differences in NICE committee decision-making that may have been justified by NICE committee autonomy, but may have resulted in delayed patient access. We have extended this work to assess differences within and across other ICIs that target programmed cell death protein 1 or programmed-death ligand 1.

METHODS: Publicly available data from all 30 NICE TAs of nivolumab, pembrolizumab, atezolizumab, and avelumab that had reached at least publication of the appraisal consultation document were reviewed.

RESULTS: Several themes were identified where variations in judgements across appraisals were observed, including committee-preferred assumptions around long-term treatment duration and effect. For example, the recommendations for four ICI appraisals in non-small cell lung cancer were contingent on a 2-year maximum treatment duration, despite varying treatment duration rules across pivotal studies. First, in TA447 (pembrolizumab), the manufacturer proposed a 2-year stopping rule aligned with KEYNOTE-024, which was accepted by NICE. In TA483 and TA484 (nivolumab), the manufacturer had the same approach accepted despite a stopping rule being absent from CheckMate-017/057. Then, when the TA520 (atezolizumab) manufacturer, in line with the pivotal OAK study, assumed no maximum treatment duration, NICE imposed a 2-year stopping rule. This contrasts with other indications where company-proposed stopping rules were dismissed.

CONCLUSIONS: Our findings indicate a desire within NICE committees for consistency in decision-making within indications, that may have contributed to unintended inconsistencies across different indications. As concluded in our original review, greater use of NICE position statements to clarify their stance on issues that span multiple appraisals would increase transparency and may improve outcomes and speed of access for patients.