The “Proportionate Approach Route” for Technology Appraisal by NICE 

The innovation of the new treatments has outpaced the rate at which NICE (The National Institute for Health and Care Excellence) appraises the treatments via its existing method of appraisal. NICE recently announcing taking a “proportionate approach” to technology appraisals is a landscape change ensuring faster guidance and efficiency gains.

A Brief Note on Status Quo:

The Technology appraisal by NICE has three elements:

  • Single Technology Appraisal (STA) which covers a single technology for a single indication.
  • Fast Track Appraisal (FTA) which covers a single technology for a single indication for a new cost-effective treatment taking shorter process and time.
  • Multiple Technology Appraisal (MTA) covers more than one technology, and/or indication.

Steps during the development of technology appraisal guidance:

The Proportionate Approach:

The principal advantage of taking on the “proportionate approach” to technology appraisals is that it, allegedly, increases the capacity of technology appraisals done by NICE. This approach can, allegedly, increase the capacity to appraise 20% more treatments for 2023-24, hence allowing more guidance and rapid and robust decision making.

The proportionate approach to technology appraisals will allow to mark off the treatment that are clinically and economically effective, prima facie, and thus applying a cursory and simpler process of evaluation. The proportionate approach will be introduced by running a series of pilots for the low-risk treatments refashioning the evaluation process to use up shorter time and rationing resources.

For example, under the streamlining approach, a process is devised such that the time taken is shortened in terms of committee meetings etc. This will involve immediate feedback from the stakeholders.

Advantages of proportionate approach:

To patients: Earlier access to the new promising medicines.

To clinicians: More options in terms of medication, procedures, and therapies to recommend to their patients.

To industry: Faster and simpler appraisal process for the treatments, greater incentive to invest in R&D.

To government: Speedier decision making and reducing procedural costs in appraisal, allow assessing complex treatments.

Some concerns:

However, there are concerns around how to identify and develop a reliable parameter for the low-risk treatments. A possibility of bias is suspected against the rare disease where the clinical and economic evidence suffers from data scarcity. Also, there is a suspected procedural overlap between the managed access fund, the innovation fund, and the cancer drug fund active in the UK.

The appraisals for some complex treatments take longer and thus, disproportionately exhaust the time and resources, exposing the simpler appraisals to constant delays and scarce resources. This warrants the necessity to invent a scheme for appraisal that is comprehensive as well as simpler in terms of assessment of treatments that are clinically and economically effective to assure best use of resources.

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Model Conceptualization and Data Analytics

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Senior Consultant

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PhD – Health Economics

Thai-Son Tong

PhD. Health Economics

Thaison Tong has extensive work experience in health economics, decision modelling and big data analysis. He has a unique mix of experience in HEOR and RWE related research in academia and pharmaceutical industry. His expertise lies in health technology assessments (HTA), health economic modelling, simulation modelling, big data analytics and decision analysis. He has hands-on experience in a range of software and programming languages including R, R Shiny, R Markdown, Python, MS Excel, VBA, and Simul8. He has substantial experience of the health care system in the UK and other European countries. 

Thaison has direct experience in building cost-effectiveness models from scratch and conducting big data analysis in several disease areas including dementia, vascular disease, and cancer. 

Thaison’s PhD focus was to develop a de novo patient level model for the evaluation of different cognitive screening tests for early detection of dementia and mild cognitive impairment in primary care. He also looked at different methods for conducting economic evaluation in health care taking a broader/societal perspective. In addition, he investigated the use of Multiple Criteria Decision Analysis (MCDA) for economic evaluation.

Thaison also holds Academic Researcher position in School of Health and Related Research (ScHARR), University of Sheffield, UK and Honorary Researcher position in University of Bristol, UK.

Thaison’s likes to meditate, and play badminton, basketball and tennis.

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Consulting and strategy

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MSc. International Economics

Shilpi Swami

MSc. International Economics

Shilpi Swami is a seasoned Health Economics and Outcomes Research (HEOR) expert with experience spanning across multiple healthcare systems and therapy areas. At her current role of Vice President, HTA and Strategy, ConnectHEOR, she provides technical and strategic leadership. Additionally, Shilpi serves as the Member Engagement Co-Chair at ISPOR Oncology Special Interest Group.

Shilpi has a comprehensive track record of leading HTA submissions and devising market access strategies on a global scale, including the EU-5, Canada, US, Latin America, Australia, and Asia. Shilpi has worked across various sectors within health economics, including academia, consulting, and biopharma. This multidimensional experience equips her with a unique ability to offer strategic insights from various stakeholders’ perspectives.

Formerly a Research Fellow at the University of York, Shilpi has made significant contributions to public health projects and the development of best practices in the academic side of health economics. In her professional endeavours, she remains dedicated to improving healthcare through data-driven insights and evidence-based research.

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Health Technology Assessment

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Scientific HTA Advisor

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Ph.D, MBA, Stockholm School of Economics

Prof. Egon Jonsson

PhD Economics

Professor Jonsson has more than 25 years of experience as a leader and researcher at national and international organizations on Health Technology Assessment (HTA) including Health Economics. He is very knowledgeable of the regulatory requirements of pharmaceuticals, medical devices and other health technologies and services, in many of the European countries, Canada, and US, as well as of several Asian countries. He has performed many syntheses of scientific findings through systematic reviews, cost-effectiveness, cost-benefit, and budget impact analyses, modelling studies, meta-analyses, RWE and HEOR studies. He is known for his ability to engage with decision makers in agencies and at the ministerial levels, and with clinicians in primary health services and hospital care as well as with patient organizations and the general public. He is good at presenting scientific findings along with their economic, medical, social and quality of life implications in such a way that it supports the uptake of effective technologies and services provided by the life sciences industry.  He has a huge international network of researchers, HTA experts, clinicians and decision makers in Governments, Academia and Industry.

Professor Jonsson received his Ph.D. and MBA from the Stockholm School of Economics in Sweden and further training at Harvard School of Public Health in the U.S. He was one of the founders of HTAi, its Society, and scientific Journal of which he was a long time Co-Editor -The International Journal of Technology Assessment in Health Care. He successfully has taken on several major roles as manager and leader of organizations in evidence-based health care; such as being the CEO of the Swedish Agency for Health Technology Assessment (SBU.se), the Leader of the WHO Health Evidence Network (WHO. Int.Hen), and as the CEO of the Institute of Health Economics in Edmonton, Canada (IHE.ca). He has done several hundreds of HTAs. His publications include more than 90 peer reviewed manuscripts, and as Editor of about 20 books on a variety of diseases and disorders. He has served as a long-time advisor to Ministers and Ministries of Health in Sweden, Vietnam and of the Government of Alberta.

Professor Jonsson has been a consultant in HTA in many countries of Europe, Asia and the former Republics of the Soviet Union, on behalf of the European Commission, WHO, the World Bank, and the Swedish Medical University Karolinska Institute.

Besides, Professor Jonsson has award on his name – ‘The Egon Jonsson Award’. This award was established in 2010, and is given annually by HTAi to the authors of an outstanding paper in the society’s official journal published over the past year.

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Kunal Hriday

MSc. Quantitative Economics

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Kunal also holds a Masters in Quantitative Economics from Indian Statistical Institute and a bachelors degree in Business Economics. Excellent in business communication, he is passionate about studying economics and welfare optimization theories.

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Raju Gautam

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Raju Gautam has extensive work experience in evidence review and synthesis, value communications, scientific publications, medical writing and project management.
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Raju also likes jogging, yoga and meditation.

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MBBS (Bachelor of Medicine and Bachelor of Surgery), PhD (Global Public Health) – University of York

Radha Sharma

MBBS, PhD (Global Public Health)

Radha Sharma is an evidence synthesis scientist with a background in medicine, public health and epidemiology. Her expertise includes global health research, epidemiological analysis of big data sets, RWE study design, literature reviews, meta-analysis, scientific writing, and qualitative health research.

With a unique combination of clinical and academic skills, Radha facilitates Health Technology Assessment (HTA) reimbursement submissions and value dossiers by conducting systematic reviews, writing and reviewing clinical sections, and effectively communicating scientific findings.

Her experience in conducting statistical and econometrics analyses, along with her in-depth knowledge of global health research and qualitative health research, ensures that the results of her systematic reviews and meta-analyses are robust and accurate.
Radha is an avid hiker and enjoys exploring the beautiful Canadian Rockies.

She also often spends her time painting on large canvases with acrylics.

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Kate Ren

PhD Probability and Statistics

Dr. Ren is our senior statistical expert and spearheads department of Statistics at ConnectHEOR. She has more than 10 years of experience in conducting statistical analysis in HTA. Kate is also a Senior Research Fellow at School of Health and Related Research (ScHARR), University of Sheffield. Kate has PhD in Probability and Statistics specialising in Bayesian methods in clinical trial design. She specializes in Bayesian methods in health economics and the elicitation of experts’ beliefs and has extensive experience of conducting evidence synthesis, including, meta-analysis, network meta-analysis, MAIC, etc.

Kate has extensive experience for critiquing network meta-analysis methods in single technology appraisals (STAs) and undertaking network meta-analyses for multi technology appraisals (MTAs) for NICE.

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Decision Modelling and AI Initiatives

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MSc – Statistics and Computing

Tushar Srivastava

MSc – Statistics and Computing

Endorsed as a ‘Global Talent’ by prestigious ‘The Royal Society, UK’, Tushar is dynamic and  enjoys approaching complex problems with a holistic approach. He also holds an MSc. in Statistics and has authored a handbook on higher Mathematics, “A concise handbook of vector space theory and field theory, Srivastava T.”

Tushar’s technical expertise lies in different techniques including cost-effectiveness modelling, budget impact modelling, simulation modelling, statistical modelling and indirect comparisons analysis. He brings a unique blend of academic research, technical modelling and statistical skills and industry professionalism to support the life science industry at every stage of the product life cycle. He has a good experience in statistical analyses, including survival analysis and health related quality of life data analysis from clinical trials.

Tushar has worked in multiple  disease areas including oncology, CVD, infectious diseases, rare-diseases such as Fabry disease, ulcerative colitis, Crohn’s disease, and multiple sclerosis. He has extensive experience of product launch in countries in Europe, the United States, Latin America, and Australia. He also holds an Academic Researcher position in ScHARR, University of Sheffield, UK.

Besides work, Tushar enjoys playing badminton, jogging, and meditating.