OBJECTIVES:

The National Institute for Health and Care Excellence (NICE) reference case states that utility values should be based on health-related quality of life (HRQoL) measures reported directly by patients and valued with public preferences, preferably using the EuroQoL-5 dimensions questionnaire (EQ-5D). We investigated the health state utility values (HSUVs) used in oncology appraisals submitted to NICE, the extent to which EQ-5D data were available, and views of the NICE Committees on alternative approaches of sourcing HSUVs.

METHODS:

NICE oncology appraisals published between January 2015 and April 2017 were reviewed; details of the drug, indication, source of base case HSUVs, Evidence Review Group (ERG) and Committee comments on the HSUVs, and final recommendation were extracted. Multiple technology appraisals, Cancer Drugs Fund reappraisals, or appraisals not using a typical 3- or 4-health state oncology health economic model were excluded.

RESULTS:

Of the 30 appraisals reviewed, 17/30 (57%) used EQ-5D data from the intervention’s pivotal trial to inform at least one HSUV; 5/30 (17%) mapped HRQoL data from the intervention’s pivotal trial to EQ-5D, 5/30 (17%) used EQ-5D data from an alternative source (e.g. a comparator clinical trial), and 3/30 (10%) did not use EQ-5D data to inform any HSUVs. Mapping to EQ-5D was generally well-received by the Committee; validated mapping algorithms from large datasets were preferred. Alternative sources of HSUVs were also accepted if HSUVs were derived from an appropriate patient population and used in previous NICE appraisals; failure to convert US-valued EQ-5D data to the UK and double-counting of adverse event disutility were strongly criticised.

CONCLUSIONS:

The majority of oncology appraisals had EQ-5D data collected from the intervention’s pivotal trial. Whilst HSUV sources deviating from the NICE reference case attracted criticism from the ERG, there are measures manufacturers may take to mitigate such feedback, and Committees appear willing to accept alternative HSUV sources.