Yesterday Carl Prescott & Anne-Marie Barnes attended the OHE Webinar ‘The Future of NICE in a Changing HTA Landscape’, in recognition of NICE’s upcoming 25th birthday & took away some really valuable insights:
1️⃣ The trajectory of HTA & the challenges
◾ Since the publication of the RWE framework, NICE has seen improvement with the quality of RWE & type of analyses used in appraisals which is really helping NICE to be in a better position to make decisions where good quality evidence is lacking.
◾ There are still challenges in how NICE deal with uncertainty in evidence or in a situation where the evidence doesn’t exist, including how this uncertainty is factored into decision making and balanced with other considerations.
◾ NICE are pleased to see the severity modifier is being used within non-oncology appraisals but overall, there are a lower number of appraisals than NICE anticipated utilising the modifier.
◾ The trend for increased number of annual appraisals is set to continue with NICE keen to consider proportionate approaches for low-risk appraisals or where the value is clear for a new treatment, this is an area which is being actively worked on – so watch this space!
2️⃣ Digital health advancements
◾ How do we create stronger alignment between NICE, MHRA, & the NHS to increase access of digital health technologies to patients?
◾ Digital technologies can improve so fast that version 2.0 could be ready before the assessment of v1.0 has even been finalised.
◾ There will be significant challenges in HTA as digital health technologies evolve utilising AI & Machine Learning – there is a need for much greater collaboration between Regulatory / Companies/ Health care systems & NICE.
3️⃣ Cost-effectiveness thresholds
◾ There has been considerable amount of research into methodology & CE modelling to increase the quality of models & certainty around the ICER, but not the same amount of research on the thresholds ICERs are assessed against.
◾ The use of sequential assessments means we are comparing assessments with the threshold, rather than with each other - how do these new treatments compare against each other, what should the new treatment displace, & (controversially), could the use of QALY/ICER league tables provide more practical output for health care systems?
◾ Having the ability to apply a modifier to the QALY is important to reflect variation in condition, but should this modification be quantifiable or deliberative? Quantification of severity, although useful, can lead to additional ethical considerations so is a deliberative approach more appropriate?
All in all, lots of positive improvements happening in the HTA space, but an acknowledgement of the challenges ahead. We are looking forward to watching things evolve over the next 25 years of NICE!