Advertisement

Do evidence review groups bias nice decisions?

      Objectives

      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.

      Methods

      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.

      Results

      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.

      Conclusions

      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.