Market Access Challenges To PD-1 Immunotherapies: Lessons From Nice

Abstract

Objectives: NICE of England and SMC of Scotland are responsible for issuing appraisal guidance for reimbursement of new health technologies. While both agencies consider clinical and cost-effectiveness in their decisions, they have unique policies and procedures and may yield different outcomes. We conducted an analysis of past appraisal decisions by NICE and SMC for oncology treatments to compare results and identify trends. MethOds: Oncology appraisal decisions from January 2012 to May 2017 were identified on the SMC website and Xcenda's Health Technology Assessment (HTA) Decision map. Appraisal decisions for both countries were evaluated and categorized as favorable, mixed, or unfavorable. Additionally, reported incremental cost-effectiveness ratio (ICER) and tumor type were compared for each decision. SMC decisions that were classified as withdrawn or superseded were not included. Results: A total of 91 decisions were identified for NICE, of which 64.8% (59) were favorable, 3.3% (3) were mixed, and 31.9% (29) were unfavorable. 110 decisions were identified for SMC, of which 40.9% (45) were favorable, 26.4% (29) were mixed, and 32.7% (36) were unfavorable. Between agencies, there were 53 pairs of decisions that were matched across 15 tumor types; of which, 62.3% (33) matched exactly, 24.5% (13) were similar (one agency's decision was favorable and the other agency's decision was mixed), and 13.2% (7) were in disagreement. All 18 NICE decisions with reported ICERs less than £30,000 received favorable guidance; but, the guidance for SMC was more varied. For the 25 SMC decisions with a reported ICER of less than £30,000, 12 were favorable, 10 were mixed, and 3 were unfavorable. cOnclusiOns: The majority (86.8%) of oncology HTA decisions by NICE and SMC were either the same or similar across tumor types. However, compared to NICE, there appears to be less association between the reported ICERs and SMC appraisal decision results.