OBJECTIVES: ITCs are indispensable for making reimbursement decisions in the absence of head-to-head clinical studies. In this international payer survey, we aimed to understand how HTA bodies and payers perceive the use and value of ITCs when assessing novel therapies and what attributes they most desire in an ITC.

METHODS: In April 2023, a web-based survey was administered via the Rapid Payer Response (RPR) online portal to 30 national and regional payer decision-makers from France, Germany, the UK, Australia, and the USA. Payer responses regarding ITC importance, use cases, attribute ranking, and endpoint preference, among other considerations, were collected for 5 days. Responses were analyzed using descriptive statistics.

RESULTS: ITCs are generally accepted for payer decision-making in Australia (100%) and in the UK (80%); their use in Germany, France, and the USA is evaluated on a case-by-case basis. Credibility of the ITC results depends primarily on the evidence base, the methods used, and the inclusion of relevant and high-quality studies. Network meta-analyses are generally well-accepted (73%) as a source of comparative effectiveness data if the methods are based on guidelines and results published in peer-reviewed journals. Results from matched-adjusted indirect and simulated treatment comparisons are considered on a case-by-case basis in all countries except Germany. Most respondents consider data obtained from randomized controlled trials as the gold standard for use in ITCs, while evidence from non-randomized studies is not favored due to the higher risk of bias and increased uncertainty.

CONCLUSIONS: The findings of this cross-sectional study reveal that despite the existence of published methodological guidance on the construction of ITCs for economic appraisal, there is broad heterogeneity and lack of transparency in the methods and application of ITCs in the healthcare decision-making process. There is a need for greater harmonization of these methods considering the evolving HTA landscape.