PNS60 CAN WE APPLY NICE COST-EFFECTIVENESS TO FRENCH EFFICIENCY OPTIONS: A COMPARISON OF SEVEN NICE AND HAS BASECASE COST-EFFECTIVENESS SCENARIOS

Abstract

To describe the impact of hypotheses and parameters in national institute for health and care excellence (NICE) and the health economic and public health commission (CEESP) of the french health autority (HAS) appraisals, on the incremental cost-effectiveness ratios (ICER) of six pharmaceutical products with a total of seven treatment indications with published cost-effectiveness analyses from both NICE and CEESP. In order to measure the impact of choices made by NICE and the CEESP on ICERs, we compared first final NICE and CEESP’s appraisals for seven indications with a focus on: methodology of analysis, time horizon, discount rates, extrapolation of clinical efficacy, sources of utility, adverse events. The analysis of the models revealed differences in the seven evaluations submitted to NICE and the CEESP. Some of these differences have an impact easy to interpret: longer time horizons and a slightly lower discount rate (3.5% vs 4.0%) were adopted in NICE submissions which individually tend to lower ICERs. Other differences regarding methodological choices are more difficult to handle when it comes to compare the ICERs, especially in the choice of comparators in five evaluations, survival extrapolation in four evaluations, model structure (semi-Markov vs partitioned survival) in two evaluations, population in two evaluations and method of estimation of adverse event in two evaluations. In order to evaluate the feasibility of comparing methodological choices used in NICE and CEESP appraisals, it is important to adapt the models to quantify the impact on ICERs. Finally, the differences regarding parameters and methodological choices used in the seven evaluations by NICE and CEESP submission showed that NICE’s choices were more favorable regarding the ICER 6 times out of 7.