OBJECTIVES: To review the trends in the usage of indirect treatment comparisons (ITCs) to support health technology assessment (HTA) in France.

METHODS: HTA assessments published by the French National Authority for Health (HAS) between 2020 and 2024 for drugs were accessed for analysis. These included new assessments, re-evaluations, and indication expansions. They were then analyzed to understand the types of ITC used, the recommendations provided by HAS on the ITCs, and the HTA outcomes.

RESULTS: A total of 806 HTA assessments were reviewed, of which 160 included ITC data submissions. A network meta-analysis (NMA) approach was utilized in more than half of the assessments (53%), followed by matching-adjusted indirect comparison (MAIC) in 19% of the cases. A very small proportion of (approximately 1%) of the assessments employed the simulated treatment comparison (STC) approach. The type of ITC used was not specified in the remaining 27% of the cases. There was no substantial difference in the likelihood of achieving a better reimbursement outcome (Clinical Added Value – CAV) when using ITCs compared to head-to-head trial data. Methodological limitations, noted in approximately 60% of the cases, were identified as one of the key reasons why conclusions about the efficacy of the ITCs could not be drawn.

CONCLUSIONS: ITCs are increasingly being used in HTA assessments to supplement clinical evidence, particularly in cases where multiple therapies are used for the same indication. Head-to-head trials may be challenging in such scenarios, making ITCs useful for comparison. Manufacturers need to critically assess both the approach and methodology used in ITCs to ensure successful HTA outcomes.