The story of HTA at NICE
Meindert Boysen, director
Centre for Health Technology
Evaluation© NICE 2018. All rights reserved. Subject to notice of rights.

The systematic evaluation of theproperties and effects of a healthtechnology, addressing the direct andintended effects of this technology, as
well as its indirect and unintended
consequences, and aimed mainly at
informing decision making regarding
health technologies.
Note: HTA is conducted by interdisciplinarygroups that use explicit analytical frameworks
drawing on a variety of methods.
23

20

The NICE portfolio in 2018
Interventionalprocedures

AdviceHealthNew
Medicines

Public Health

NICE

Guidelines

Appraisals
New MedicalTechnologies &Diagnostics

Social Care
Qualitystandards

Indicators

51.

Prepare guidance and standards on topics that reflect national priorities for the population’s
health and care2.

Use evidence that is relevant, reliable and robust

3.

Set out frameworks for interpreting the evidence in our process and methods manuals, andreview them regularly

4.

Use independent advisory committees to develop recommendations

5.

Take into account the advice and experience of people using services, health and social careprofessionals, commissioners and providers

6.

Base our recommendations on an assessment of population benefits and value for money

7.

Give people interested in the topic area the opportunity to comment on and influence ourrecommendations

8.

Lead work with partners in the health and care system to encourage and support the adoptionof our recommendations
9.

Assess the need to update our publications in line with new evidence

10. Propose new research questions and data collection to resolve uncertainties in the evidence
6Flexible decision-making: current
approach£20,000 per QALY

£30,000 per QALY
£50,000 per QALY (x2.5)

Appraising Life-Extending,
End of Life Treatments
Criteria:• Life expectancy < 24 months• Extension to life > 3 months

Allows Appraisal Committee to consider:• Giving greater weight to QALYs achieved in laterstage of terminal disease• The magnitude of additional weight needed tobring QALY benefits within a range that is normally
accepted as good use of NHS resources

In practice, it means that drugs with ICERs > £30,000 can be approved for thispopulation.
However, the Appraisal Committee must be satisfied that both evidence andassumptions are plausible

The NHS Constitution“You have the right to drugs andtreatments that have been
recommended by NICE for use inthe NHS, if your doctor says they
are clinically appropriate for you.”10

Breakdown of decisions containedin appraisals 1 – 559
1 March 2000 to 31 January 2019
STAMTATotal

1 January 2019
to 31 January2019

Yes

182 (49%)275 (61%)457 (56%)

0 (0%)

Optimised

97 (26%)89 (20%)186 (23%)

1 (20%)CDF

24 (7%)

0 (0%)

24 (3%)

3 (60%)

Only in research

5 (1%)

23 (5%)

28 (3%)

0 (0%)

No

63 (17%)61 (14%)124 (15%)

1 (20%)

371 (100%)

448 (100%)

819 (100%)

5 (100%)Recommendation

TOTAL

STA, single technology appraisal; MTA, multiple technology appraisal

NB: 13 withdrawn recommendations and 38 non-submission recommendations have been excludedImplementing the budget impact test
Reconcile the roles of NICE and NHS England• Clinical & cost effectiveness → Effective service delivery

Flexibility in the adoption of cost-effective, high budget impact
technologies• Balance value and affordability• Avoid compromising other forms of careBudget impact threshold: £20m/year in first 3 years

Negotiate accessarrangements

Variation to the 90
day funding direction

BIT considerations @ company submission stage

7060

Number ofTests

Financial impact
59%

2017/1850

45

40
30
1720
12100
2017/18

2018/19

No. of submissions assessed

Topics that met the BI test

Total number of budget
impact tests

59£20 million or above

1220%£15 million to £19,999 million

814%

Below £14,999 million

3966%

2018/19 (April – Oct)
Total number of budget
impact tests
45£20 million or above

1738%£15 million to £19,999 million

24%

Below £14,999 million

2658%

Objectives of the new Cancer Drugs Fund (CDF)
29 July 2016, a new approach to the appraisal and funding ofcancer drugs in England began operating in a partnership
between NICE and NHS England.
The objectives of the reformed CDF are:
• To provide faster access to newcancer treatments• Drive stronger value for money for

taxpayers• Address uncertainty about theeffects of new cancer treatments
through ongoing data collection• Offer a new fast-track route to themost promising drugs whencompanies price responsibly.

Published CDF Managed Access Agreements
2520No. of topics

151050Managed Access Agreements are timelimited periods to collect further data.
Two have ended, both with positive guidanceBreakdown of decisions in published technology
appraisals for anti-cancer agents
1 March 2000 to 31 July 2016

01 Aug 2016 to 30 Apr 2018

Non-submissions and withdrawn recommendations have been excluded from both analyses
16

Highly Specialised TechnologiesQALY weighting for HSTs
A perceived societal preference in circumstances where people experience
substantial incremental quantity and/or quality of life benefits• Valuing those QALYs more highly than other types of QALYs

This has the impact of re-setting the incremental cost effectiveness ratio
higher than the £100,000/QALY threshold
Incremental QALYs gained(per patient, using lifetime horizon)

Weight versus 100k/QALY

Less than or equal to 101

10 - 30

Between 1 and 3 (using equal increments)

Greater than 303