OBJECTIVES: The commercial landscape for pharmaceuticals is becoming increasingly complex with increasing numbers of interventions being recommended by the National Institute for Health and Care Excellence (NICE) with confidential commercial arrangements. These interventions subsequently become part of the treatment pathway in future NICE technology appraisals (TAs). The number of NICE TAs where inclusion of other confidential commercial arrangements results in the intervention company not being able to clearly understand the true cost-effectiveness of their new intervention is increasing. This study reviewed published NICE guidance to assess how often confidential commercial arrangements were included in NICE TA evaluations.

METHODS: NICE TA guidance published between April 2021 and 2022 was identified. For each appraisal identified, information on confidential commercial arrangements for the: intervention, combination treatment(s), comparator(s) or subsequent treatment(s) was extracted. Terminated appraisals were excluded.

RESULTS: Seventy-six pieces of guidance were published between April 2021 and 2022 (excluding terminations). Four appraisals (5.3%) had no commercial arrangements. Seventy-two (94.7%) had a confidential commercial arrangement in the treatment pathway. Sixty-nine (95.8%) of these had a commercial arrangement for the intervention, of which 49 (71.0%) also had a confidential commercial arrangement elsewhere in the pathway. Three appraisals (4.2%) had no commercial arrangement for the intervention but had a confidential commercial arrangement elsewhere in the pathway.

CONCLUSIONS: Almost all NICE TAs now include treatments that have a confidential commercial arrangement. Where there are confidential commercial arrangements for treatments in the pathway other than the intervention, NICE is unable to publish the committee’s decision-making incremental cost-effectiveness ratio and the intervention company may not know its true cost-effectiveness. This is an increasingly common problem affecting NICE guidance production and work continues to find a solution that balances transparency of the intervention’s cost-effectiveness with protecting confidential pricing information of other treatments in the appraisal.