OBJECTIVES: The NICE manual for health technology evaluations (2022) recommends that cost-effectiveness analyses utilize a probabilistic base case and probabilistic scenario analyses. This contrasts with the previous recommendation of using deterministic analyses. A review was conducted to assess the extent to which these guidelines are being followed.

METHODS: A literature review of NICE Technology Appraisals (TAs) within oncology published between January 2023 and May 2024 was undertaken. The following data items were extracted: inclusion of a probabilistic base case, inclusion of probabilistic scenario analyses, manufacturer rationale for inclusion/exclusion, external assessment group (EAG) and Committee critique, and impact on overall reimbursement decision. Screening and data extraction were conducted by two reviewers. Any outstanding issues were resolved with the help of a third independent assessor.

RESULTS: A total of 128 NICE TAs were included for screening. TAs in non-oncology indications (n=54), those that did not utilize a probabilistic base case (n=42) or those that were terminated (n=24) were excluded. Of the 8 included TAs that utilized a probabilistic base case in line with NICE guidance, 2 utilized probabilistic scenario analyses. The main parameters assessed within the probabilistic scenario analyses included parametric survival curves and costs. The rationale for not including probabilistic scenario analyses included computational burdens and long running times; therefore, parameters with greater uncertainty (e.g., parametric survival curves) were sometimes prioritized. There were no specific critiques from the EAG or Committee regarding the use of these approaches.

CONCLUSIONS: Despite NICE’s current recommendations, a limited number of oncology TAs utilized probabilistic base cases and scenario analyses within their submissions. Limited justifications from manufacturers for deviating from NICE guidance and a lack of critique from assessors may mean that more time is required to fully capture and understand the impact of non-adherence to these guidelines in the near future.