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How do pharmaceutical companies model survival of cancer patients? A review of NICE Single Technology Appraisals in 2017
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Gallacher, Daniel C., Auguste, Peter and Connock, M. (2019) How do pharmaceutical companies model survival of cancer patients? A review of NICE Single Technology Appraisals in 2017. International Journal of Technology Assessment in Health Care, 35 (2). pp. 160-167. doi:10.1017/S0266462319000175 ISSN 0266-4623.
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Official URL: http://dx.doi.org/10.1017/S0266462319000175
Abstract
Objectives
Before an intervention is publicly funded within the United Kingdom, the cost-effectiveness is assessed by the National Institute of Health and Care Excellence (NICE). The efficacy of an intervention across the patients’ lifetime is often influential of the cost-effectiveness analyses, but is associated with large uncertainties. We reviewed committee documents containing company submissions and evidence review group (ERG) reports to establish the methods used when extrapolating survival data, whether these adhered to NICE Technical Support Document (TSD) 14, and how uncertainty was addressed.
Methods
A systematic search was completed on the NHS Evidence Search webpage limited to single technology appraisals of cancer interventions published in 2017, with information obtained from the NICE Web site.
Results
Twenty-eight appraisals were identified, covering twenty-two interventions across eighteen diseases. Every economic model used parametric curves to model survival. All submissions used goodness-of-fit statistics and plausibility of extrapolations when selecting a parametric curve. Twenty-five submissions considered alternate parametric curves in scenario analyses. Six submissions reported including the parameters of the survival curves in the probabilistic sensitivity analysis. ERGs agreed with the company's choice of parametric curve in nine appraisals, and agreed with all major survival-related assumptions in two appraisals.
Conclusions
TSD 14 on survival extrapolation was followed in all appraisals. Despite this, the choice of parametric curve remains subjective. Recent developments in Bayesian approaches to extrapolation are not implemented. More precise guidance on the selection of curves and modelling of uncertainty may reduce subjectivity, accelerating the appraisal process.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer) | ||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) > Warwick Evidence Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Cancer -- Treatment -- Standards, Pharmaceutical industry, Antineoplastic agents | ||||||
| Journal or Publication Title: | International Journal of Technology Assessment in Health Care | ||||||
| Publisher: | Cambridge University Press | ||||||
| ISSN: | 0266-4623 | ||||||
| Official Date: | 24 April 2019 | ||||||
| Dates: |
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| Volume: | 35 | ||||||
| Number: | 2 | ||||||
| Page Range: | pp. 160-167 | ||||||
| DOI: | 10.1017/S0266462319000175 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Restricted or Subscription Access | ||||||
| Copyright Holders: | © Cambridge University Press 2019 | ||||||
| Date of first compliant deposit: | 2 May 2019 | ||||||
| Date of first compliant Open Access: | 24 October 2019 |
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