OBJECTIVES: NICE recently introduced the proportionate approach to technology appraisals. This includes streamlined cost-comparison appraisals (sCCAs). We sought to characterize key benefits and issues in published sCCAs.

METHODS: We identified and reviewed all sCCAs published by NICE between January 2023 and May 2024, focusing on decision problems, comparators, methods, key issues, interpretation of results and recommendations. Efficacy considerations are reported separately.

RESULTS: Of 91 published HTA appraisals (excluding terminations), 8 were sCCAs: 4 in autoimmune diseases; 4 in other disease types (none in oncology). All received positive recommendations. The average time from invitation to participate to final guidance publication was 30 weeks (range, 18–60). One sCCA was published on the same day as MHRA marketing authorization; 2 were published within 6 weeks. Five of 8 sCCAs had narrower decision problems than the population defined in the NICE scope, mainly due to expected positioning in the NHS. All sCCAs had a narrower comparator selection than listed in the NICE scope (1–3 selected vs up to 15 listed), mainly due to proposed positioning, wide usage of selected comparator(s) in clinical practice and similar expected efficacy and safety. EAG and NICE generally accepted the selected decision problem and comparators. All sCCAs included acquisition costs, 4 included administration costs and 3 included other costs (pre-initiation test [n=1]; concomitant medication [n=2]; pre-medication [n=1]; monitoring [n=1]). EAG’s main concerns related to dosage calculations, response rates, long-term treatment adherence and discontinuation, and choice of subsequent treatment(s). In 3 sCCAs, a new intervention cost was lower than that of one comparator, but similar or higher than that of another comparator. NICE accepted this in agreement with their sCCA methods.

CONCLUSIONS: sCCAs demonstrated timely guideline publication, resulting in faster patient access to new treatment options. However, decision problem, comparators and cost components need to be carefully considered and adequately justified.