Acceptance of Cure Assumptions in NICE Oncology Technology Appraisals: Remission Impossible?

OBJECTIVES: Novel oncology treatments offer potential for long-term survival and even cure. Previous research has suggested that early attempts at incorporating cure in submissions to NICE were generally not accepted.¹ The use and acceptance of cure assumptions in cost-effectiveness analyses submitted in recent NICE oncology appraisals was reinvestigated.

METHODS: The NICE website was searched on 16^th May 2024 for completed technology appraisals in oncology. Information regarding the modelling approach was extracted from the ten most recent appraisals where the manufacturer’s cost-effectiveness analysis incorporated a cure assumption.

RESULTS: Ten appraisals explicitly incorporating a cure assumption were identified after searching the 45 most recent oncology appraisals. Four appraisals utilised mixture cure models and six modelled cure where survival was informed by general population mortality after a certain timepoint for a proportion of patients. Committees accepted the modelled cure assumption in the majority (n=7) of appraisals. However, limited trial follow-up (n=7), and the mortality and utility experienced by cured patients (n=4) were cited as key sources of uncertainty. Clinical opinion remains an important source of justification, informing the choice of cure modelling in the majority of appraisals (n=7), whilst Technical Support Document 21 was cited in six appraisals as supporting methodology.

CONCLUSIONS: Cure assumptions appear to be increasingly considered appropriate for decision-making. Despite this, uncertainty when modelling cure remains. Clinical expectation of cure remains an important factor in Committees’ acceptance of cure, particularly where there are no long-term trial data showing clear curative potential. Recently published guidance on methodological aspects of cure modelling appears to have lent methodological support and likely contributed to its increasing acceptance in oncology appraisals.

1. Micallef J, et al. Capturing The Value Of Potentially Curative Oncology Therapies: Lessons From The Use And Acceptance Of Cure Modelling Assumptions In NICE Technology Appraisals. Value in Health, Volume 25, Issue 1, S171 - S172.