Is market access for oncology treatments easier in England than for non-oncology treatments? An analysis of NICE single technology appraisals from 2017-2019

OBJECTIVES : The National Institute of Health and Care Excellence (NICE) undertakes clinical and cost-effectiveness assessments of pharmaceutical products. Products assessed by NICE can be either recommended, recommended with restrictions (i.e. optimised) or not recommended. Oncology products may also be recommended for use within the cancer drugs fund (CDF). This study compares the outcomes for oncology and non-oncology appraisals conducted by NICE.

METHODS : NICE single technology appraisals (STAs) published between January 2017 and January 2019 were identified. For each appraisal, outcomes of draft appraisal consultation documents (ACDs) and final appraisal determinations (FADs) were extracted. Outcomes of oncology and non-oncology appraisals were then analysed.

RESULTS : A total of 98 appraisals were identified, of which 66% and 34% were for oncology and non-oncology indications, respectively. ACDs were published for 74% of oncology appraisals and 48% of non-oncology appraisals. Nearly all oncology ACDs were “not recommended” (96%), however non-oncology ACDs were either “not recommended” (56%) or recommended with restrictions (44%). Nevertheless, at FAD, a similar proportion of oncology and non-oncology appraisals received positive recommendations (89% vs. 88%, respectively). However, a greater proportion of non-oncology indications than oncology indications were optimised (55% vs. 26%). Of the positive oncology recommendations, 32% were recommended for use within the CDF. In terms of financial agreements, 69% of positive non-oncology appraisals were subject to patient access schemes (PAS) or complex arrangements whilst 31% had no financial agreement. In contrast, all but one (2%) of positive oncology appraisals were subject to a financial agreement.

CONCLUSIONS : Overall, oncology and non-oncology appraisals receive similar rates of positive recommendations. However, whilst positive oncology recommendations generally apply for all eligible patients, non-oncology appraisals are more likely to be recommended for only a subset of the labelled population. Nevertheless, although oncology appraisals are achieving greater access, they are more likely to be subject to financial arrangements.