OBJECTIVES: In February 2022, NICE updated their manuals for methods, processes and topic selection for technology assessment (TA). One change was the removal of fast-track appraisal (FTA), introduced in 2017. Treatments were eligible for FTA via two routes: incremental cost per quality-adjusted life year gained of <£10,000 (low ICER route); or equivalent efficacy and safety at lower cost (cost comparison route). FTA has been replaced by a formal cost comparison process for treatments with equivalent efficacy and safety, and lower cost compared with an existing recommended treatment. This research aims to reflect on the FTA process, to understand the methods used during their development, and to identify learnings for future cost comparison assessments.

METHODS: We reviewed NICE TAs from 01/04/2017–13/06/2022 to identify FTAs. We extracted data on FTA route and methodology.

RESULTS: We identified 289 completed TAs, of which, 12 were FTAs. A further three FTAs in development had final draft guidance available on the NICE website. All 15 treatments assessed received a positive recommendation (with or without restrictions). One FTA was submitted via the low ICER route. The remaining 14 appraisals were submitted via a cost comparison route. Choice of comparator was key and typically included consideration of market share and product displacement. Uncertainty around evidence of equivalence typically arose from lack of long-term clinical data. Cost comparisons were generally of short time horizon and focused on drug acquisition cost.

CONCLUSIONS: Only 15 FTAs were identified in this review. This indicates a significant underuse of FTA. The new cost comparison route will aim to increase the speed of assessment for treatments with equivalent efficacy and safety compared with existing therapies, to provide earlier access for patients. The methods of cost comparison identified via this review remain relevant for future assessments.