OBJECTIVES: TtD from HTA agencies impacts patient care through access to new therapies. The objective of this review was to assess variability in review time of appraisals from NICE and CADTH.

METHODS: NICE and CADTH websites were screened for recommendations published in the last 10 years. Start date was defined as manufacturer submission date, and where unavailable, date of final scope publication. End-date was defined as publication of guidance (NICE) and issue of final recommendation (CADTH).

RESULTS: After removing terminated appraisals and those without submission dates, 456 and 647 appraisals from NICE and CADTH, respectively, were reviewed. Among NICE appraisals, average days (range) TtD was 394d (79-2063) with significantly longer times for multiple technology appraisals (MTAs) (627d (142-1591, p<0.001) and highly specialized technologies (495d (239-1134, p=0.011) compared to single technologies appraisals (STAs) (367d (79-2063). Compared to negative recommendations, STAs with positive recommendations had significantly shorter TtD (p=0.03). No significant difference was observed between oncology and non-oncology indications; certain therapeutic areas experienced longer TtD (kidney conditions, 615d; cystic fibrosis, 533d). NICE reviewed 20.1% of STAs and 18.9% of MTAs within minimum expected timeframes of 238d and 350d, respectively. Among CADTH appraisals, TtD was 228d (114-707) with non-oncology indications requiring a longer TtD compared to oncology appraisals (p=0.02). Therapeutic areas with the longest TtD were neurological (250d) and skin conditions (274d). Both the number of appraisals and TtD (p<0.001) increased from 2012 to 2022. CADTH reviewed 18.2% submissions within the target of 180 calendar days.

CONCLUSIONS: A limitation of this analysis is overestimation of review times given broad inclusion criteria and missing data for some appraisals. Restricted decisions are associated with longer process times, potentially leading to delay of the evaluations from NICE or CADTH within their target timeframe. A more advanced statistical technique could be used to confirm the current findings.