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.
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.
Authors – Tushar Srivastava, Jyoti Sharma