ISPOR Europe 2023: Can Just Three PICOs be Feasible for Oncology Assessments with the Joint EU HTA Framework, Whilst Considering All 27 Member States Specificities?



From 2025, oncology treatments will use the Joint EU Health Technology Assessment (HTA) process for clinical evaluation. Prior to the submission, each member state (MS) will define PICOs (Population, Intervention, Comparator, Outcomes) using a survey during scoping. PICOs help specify the assessment framework and intend to be consolidated into 2-3 per assessment. We aim to understand if this is feasible by analysing recent HTA assessments for oncology treatments to estimate the number of PICOs that may have been proposed by MS.


EU4 Oncology HTA assessments since 2021 were identified using HTA agency databases. Treatments assessed in at least 3 countries were selected and PICOs were found or inferred from all publicly available HTA assessments from all MS. PICOs were consolidated according to the Practical Guideline Scoping Process from EUnetHTA 21.


5 oncology treatments assessed in all EU4 countries were identified: avelumab for urothelial carcinoma, olaparib in combination with bevacizumab for ovarian carcinoma, Brexucabtagene autoleucel for mantel cell lymphoma, atezolizumab in combination with bevacizumab for hepatocellular carcinoma and nivolumab for squamous cell carcinoma of the oesophagus. Additionally, trastuzumab deruxtecan for breast cancer was assessed in the EU4 except Italy. PICOs were identified from MS HTA assessment reports and consolidated, we found 4, 8, 13, 6, 6, and 13 PICOs respectively. The high number of PICOs was due either to subpopulations or differences in the comparator.


The number of PICOs following consolidation for each investigated treatment was higher than the 2-3 that the Joint EU HTA is aiming for. MS-specific heterogeneity in population and treatment practices are exemplified by the number of PICOs and may make the Joint EU HTA’s aim to harmonise assessments challenging. Moreover, if the MS feels the Joint Assessment has not addressed their needs it may lead to duplication due to additional national submission.

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