The Influence of the National Institute for Health and Care Excellence on Other Health Technology Appraisal Markets

OBJECTIVES: The National Institute for Health and Care Excellence (NICE) conducts health technology appraisals (HTAs) and makes recommendations on the use of treatments in NHS England and Wales. This study assessed the influence of NICE on other HTA bodies in terms of methodological approach and reimbursement decisions.

METHODS: A targeted literature review (TLR) of electronic databases and congresses was conducted on 20^th October 2022 to identify publications reporting the influence of NICE recommendations or HTA methodologies on HTAs in other markets. To supplement the TLR, a survey was conducted with 24 employees responsible for HTA submissions across 21 countries and 6 continents within Takeda, a global biopharmaceutical company. Survey questions focused on the alignment of methodological requirements between NICE and other HTA bodies, the influence of recommendations made by NICE, and the efficiency of developing submissions for other HTA bodies following NICE. Based on the TLR and survey results, structured interviews were conducted with market access leads within Takeda for 14 countries to gain deeper insights. Methodology guides were analyzed for CADTH (Canada), CONITEC (Brazil), NoMA (Norway), ISPOR (Global), and PBAC (Australia) for alignment to NICE.

RESULTS: Similarities were identified between NICE’s methodological requirements and those of other markets. The greatest divergence was observed for economic evaluations; driven by requirements for country-specific model inputs. The influence of NICE’s recommendations was nuanced, varied, and rarely explicitly acknowledged; a degree of unquantifiable impact was observed, with negative recommendations more influential than positive ones. Final decisions by other HTA bodies were autonomous.

CONCLUSIONS: The markets identified as most influenced by NICE in terms of reimbursement decisions and methodological alignment were: Australia, Brazil, Canada, Denmark, Ireland, Italy, Japan, Norway, Poland, Romania, Sweden, and Taiwan. This influence is most notable in methodological requirements however negative recommendations from NICE also impact HTAs in other countries.