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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

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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
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
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:
DateEvent
24 April 2019Published
21 February 2019Accepted
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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