OBJECTIVES: It is critical to compare a new treatment to the standard treatments in support of HTA submissions. In the absence of direct comparison, several HTA agencies have documented their interest in obtaining results from ITC (NICE-UK, G-BA-Germany). Decision Support Unit (DSU) 18 brought formal submission guidelines on matching adjusted indirect comparisons (MAICs) and simulated treatment comparisons (STCs) where traditional NMA was not feasible. This study aimed to review the technology appraisals from NICE to assess the use of MAIC methods.

METHODS: All oncology submissions reviewed by NICE UK between 2018 and 2023 were included in the review.

RESULTS: Thirty-five submissions reporting the use of MAIC were identified. Among these, the majority of the TAs were conducted in NSCLC (n=7), followed by multiple myeloma (N=4), breast cancer (n=3), acute lymphoblastic leukemia (n=3), colorectal cancer (n=2), urothelial carcinoma (n=2) and follicular lymphoma (n=2). Twenty-five submissions used unanchored MAIC to create virtual connections in the unconnected networks derived majorly from single-arm trials. One MAIC was performed using historical control. It was noted that the beneficial effects were generally higher in the MAICs than in the naive indirect comparisons. The use of MAIC was considered appropriate by ERG in majority of the cases and 30 out of 35 submissions received positive recommendation by NICE. One of the major limitations was unavailability of data from randomised controlled trials, variation in population across studies due to which important prognostic factors could not be adjusted and small sample size for various subgroups within a study.

CONCLUSIONS: MAICs allows to adjust the between-trial differences in patient and disease characteristics at baseline and is being widely used and accepted by the HTA bodies after NICE DSU guidelines.