Increasing Termination Rates of NICE Technology and Highly Specialised Technology Appraisals

OBJECTIVES: This study investigated the termination rates of the National Institute for Health and Care Excellence (NICE) technology appraisals (TAs) and highly specialised technologies (HSTs) across all disease areas, focusing on oncology and rare diseases, and aimed to explain the observed trends.

METHODS: A retrospective analysis was conducted on NICE TAs/HSTs published between January 2018 and May 2024. The disease area and outcome of each appraisal were examined, and the annual termination rates were calculated.

RESULTS: The overall termination rate was 3% in 2018, rising sharply to 19% in 2019 and increasing to 23% in 2020. It slightly fluctuated in subsequent years: 21% in 2021, 24% in 2022, 18% in 2023, and spiking to 29% in 2024 up to 31 May. Oncology termination rates were consistently higher than the overall average: 5% in 2018, 26% in 2019, 18% in 2020, 24% in 2021, 25% in 2022, 19% in 2023, and 18% in 2024 up to 31 May. Rare disease termination rates were also notably high for products that were routed to TA: 3% in 2018, 28% in 2019, 29% in 2020, 27% in 2021, 32% in 2022, and 21% in 2023. No HSTs were terminated between 2018 and 2024.

CONCLUSIONS: Increasing termination rates coincide with introduction of the 2019 Voluntary Scheme for Branded Medicines Pricing and Access, whereby NICE became responsible for evaluating all new active substances (NAS). Consequently, many new treatments entered the NICE work programme irrespective of whether companies were planning a UK launch. Additionally, NICE appears to have taken a more proactive approach to terminate stagnant appraisals. Thus, the high post-2019 termination rates could be attributed to changes in the Voluntary Scheme and NICE’s proactive approach to manage its work programme. With all NAS now referred to NICE there is a benchmark for comparing termination rates.