OBJECTIVES:

The National Institute for Health and Care Excellence (NICE) proposes a fast-track cost-comparison appraisal pathway (FTA), as an expedited reimbursement route for health technologies associated with similar or greater health benefits, at similar or lower costs, than technologies already recommended for the same indication. NICE FTAs were reviewed to investigate the use and acceptance of clinical evidence provided to support the cost-comparison criteria.

METHODS:

NICE FTAs from April 2017 (FTA pathway launch) until June 2022 with published committee papers were identified. Details of the evidence provided to justify the cost-comparison criteria and critique received by Evidence Assessment Groups (EAGs) and NICE committees were extracted.

RESULTS:

11 FTAs were identified, spanning several therapeutic areas: plaque psoriasis (n=4), ophthalmology (n=4) and arthritis (n=3), covering 8 indications. In two indications, multiple FTAs had been conducted (n=3 and n=2). In 9/11 FTAs, the intervention shared a mechanism of action with at least one comparator. Head-to-head evidence was available between the intervention and at least one comparator in 6 FTAs, including one non-inferiority trial. All FTAs presented indirect treatment comparisons (ITCs), including 10 network meta-analyses (NMAs) and one Bucher ITC. In 3/5 FTAs without head-to-head evidence, the EAG/Committee raised concerns regarding uncertainty in the indirect comparisons informing the case for similar benefits. In all cases, the intervention was recommended.

CONCLUSIONS:

Fast-track cost comparison appraisals have only been utilised in a few therapeutic areas, typically in cases where the intervention shared a mechanism of action with at least one comparator. Head-to-head trials and NMAs were most frequently presented together to demonstrate similar or greater efficacy for the intervention, but the case for similar benefits was considered more uncertain when relying solely on indirect evidence. Lessons from previous FTAs may be valuable to inform how NICE can expand its capacity through the new NICE PATT (Proportional Approach to Technology Appraisals).