OBJECTIVES: Since 2017, the National Institute for Health and Care Excellence (NICE) has accepted submissions incorporating cost-comparison analyses via the fast-track appraisal (2017–Jan 2022) and the updated cost-comparison appraisal (Feb 2022–present) routes. These submission routes are intended for therapies that provide similar health benefits at similar or lower cost compared to previously recommended therapies for the same patient population.

This research aimed to analyze the selection of comparators in cost-comparison submissions in relation to those specified in the original NICE scopes, and to identify methods used to determine comparable health benefits of therapies included in cost-comparison submissions.

METHODS: A search of the NICE website was executed in March 2023 and updated in June 2024 using the search term “cost-comparison” with “Guidance” set as a search filter. Technology appraisals were selected for the analysis if they were submitted using the fast-track appraisal (2017–Jan 2022) or updated cost-comparison (Feb 2022–present) submission route, and if they received a positive recommendation. In addition, “cost-minimization” was searched, but returned no results for inclusion in the analysis based on the specified criteria.

RESULTS: A total of 28 NICE cost-comparison technology appraisals were included in the analysis. In these technology appraisals, an average of 7.2 (range: 1–18) comparators was included in the original NICE scope, while an average of 2.1 (range: 1–7) comparators was included in the submissions. To demonstrate comparable efficacy, 27 (96.4%) submissions included an indirect treatment comparison, 9 (32.1%) included head-to-head comparisons from a clinical trial, and 8 (28.6%) included both forms of evidence.

CONCLUSIONS: Almost all cost-comparison submissions included fewer comparators than were identified in their respective NICE scopes. Only one submission relied solely on a head-to-head comparison, indicating that indirect treatment comparisons are acceptable to demonstrate similar health benefits in NICE cost-comparison submissions.