Do evidence review groups bias nice decisions?


      NICE designates one of nine independent academic centers as an Evidence Review Group(ERG) or Assessment Group(AG) to systematically review the clinical efficacy and cost-effectiveness of a product or products based on a manufacturer-submitted dossier or on published evidence. The ERG/AG’s report is integral to NICE’s decision-making process. This presentation explores whether NICE appraisals—particularly final reimbursement decisions—vary based on which ERG/AG was consulted. This evaluation is important from policy and industry perspectives as it can demonstrate whether NICE’s choice of ERG/AG is a potential source of bias in the technology appraisal process. To explore this topic, we examine clinical and economic factors within NICE appraisals influenced by different ERG/AGs.


      Reimbursement decision, therapeutic area (TA), manufacturer base-case ICER, NICE’s most plausible ICER, and clinical and economic rationales for decision were extracted from NICE technology appraisal guidances from 2003-present. These factors were compared across ERG/AGs.


      NICE reviewed a total of 305 indications, with 72% resulting in positive decisions. Eleven different ERG/AGs were commissioned. There was no difference in rates of positive decisions between the different ERG/AGs (p=.69) though there was a wide range (mean = 72% [71% - 89%]). BMJ had the lowest rate of positive decisions and Warwick Evidence had the highest. There were differences in the number of oncology drugs reviewed by ERG/AG: Kleijnen Systematic Reviews assessed the most (60%) while Aberdeen HTA Group evaluated the fewest (4.6%). The presentation will show rates of positive decisions and clinical and economic rationales for decision by ERG/AG while controlling for TA. The presentation will also compare the most plausible ICERs and manufacturer base-case ICERs by ERG/AG.


      This study is the first systematic investigation of the influence of ERG/AGs on NICE reimbursement decisions. We will examine the components of the clinical and economic assessments as well as reimbursement decisions by ERG/AG.