OBJECTIVES: The National Institute for Health and Care Excellence (NICE) conducts health technology assessments (HTAs) in England. The HTA process requires the committee to consider uncertainty in their decision on the cost effectiveness of new technologies. This study aims to understand the types of uncertainties highlighted, explore potential trends of uncertainties raised by the committees, and understand NICE's approach to account for these.

METHODS: 30 recently published NICE appraisals (June 2023-November 2023) were identified and extracted. Categorisation was done based on the nature and frequency of occurrence. The alignment between committee decisions, company's inputs, and Evidence Assessment Group's (EAG) recommendations was analysed. Qualitative assessment on the resulting committee decision was evaluated in the context of the available evidence.

RESULTS: The preliminary findings indicate that the most frequently (32%) raised uncertainties pertain to clinical parameters such as trial data and patient population. Methodological concerns, such as trial design and validity of the data used in the cost-effectiveness models were also common (28%). For the majority of key issues raised, the committee aligned to the EAG proposed assumption, with remaining assumptions falling between company's original submission and EAG assumptions or alternative assumptions proposed by the committee.

CONCLUSIONS: The results demonstrate a close alignment between the committees and the EAG, which bring into question the role of the EAG and committee's attitude to risk within NICE's decision-making process. This approach, while ensuring robust scrutiny of evidence, potentially underestimates the value of new medicines and delaying access to innovative treatments in England.