How cost-effectiveness estimates differ between the UK and US
OBJECTIVES: To determine if there is a difference between incremental cost-effectiveness ratios (ICERs) in oncology calculated by the Institute for Clinical and Economic Review (ICER) in the US and the National Institute for Health and Care Excellence (NICE) in the UK, and if any differences are solely driven by drug costs.
METHODS: ICER Final Evidence Reports were identified in oncology between January 2015 and December 2017. The corresponding NICE technology appraisal documents were then identified, where available. Where indications and comparators were comparable to those from ICER, the ICERs and drug unit costs were identified from both the NICE and ICER documents. If NICE were unable to identify a most plausible ICER, the ICER that most influenced their recommendation was used.
RESULTS: 3 ICER reports were identified, covering 15 therapies across NSCLC, multiple myeloma and ovarian cancer. Of these, 7 comparable NICE final technology appraisal or appraisal consultation documents were available across NSCLC and multiple myeloma. The mean difference between the NICE and ICER ICERs was $148,591 – $160,468 per QALY, depending on whether lower or upper ICERs from NICE were considered. The ICER ICERs were on average 4.53 – 4.98 times greater than those of NICE, while drug unit costs were on average 2.16 times greater. This difference was primarily driven by the multiple myeloma indication.
CONCLUSIONS: Cost-effectiveness is widely used by Health Technology Assessment (HTA) bodies to make decisions regarding health interventions, but controversies remain due to its variability and difficulty in interpretation. Here we show that the ICERs calculated by ICER for several recent oncology drugs were substantially higher than those of NICE, and that drug unit costs in the United States was not the sole driver of these differences. However, ICER’s higher cost-effectiveness threshold compared to NICE means that these higher ICERs may still be considered cost-effective.