OBJECTIVES: A key goal of a nationalized health care system is not only to improve health outcomes but reduce inequity in health. Equity considerations are typically highlighted and discussed in health technology assessment (HTA) submissions, subsequent evidence reviews, and committee appraisals. Here, we assess equity considerations raised in oncology HTAs submitted to the National Institute for Health and Care Excellence (NICE) over the previous 2 years.

METHODS: Documents (i.e. company submission, final appraisal document, and committee papers) from oncology HTAs submitted to NICE in the last two years (03/2022-03/2024) were reviewed to understand whether equity was considered in the underlying systematic review, economic model, and/or by the evidence review group (ERG), NICE review committee, or patient groups. Relevant data were extracted by a single researcher, with 20% validated by a second, independent researcher. Extracted data were reviewed to synthesize trends related to equity in HTAs.

RESULTS: Equity concerns were raised by the company, patient groups, or clinical experts in 30/70 submissions. Protected characteristics most frequently flagged were related to race/ethnicity/culture (12/70), age (12/70), and geography/access (12/70). Equity concerns were raised by the company in 18 submissions, 11 of which presented relevant subgroup analyses to address the issue. The ERG disagreed with the company’s handling of equity in 4 submissions (2 for inappropriate QALY weightings, 2 for insufficient clinical evidence for relevant subgroups). In most submissions, the NICE committee concluded that its recommendation would not affect protected groups differently or that geographic inequity within the National Health Service (NHS) was out of its control and hence not considered in the final appraisal.

CONCLUSIONS: Though equity concerns are frequently raised in oncology HTA submissions, they are often not factored into the evidence submission or final appraisal, highlighting a need for guidelines or more practical measures to ensure health inequities are fully captured in the decision-making process.