The challenge

Patient-centred outcomes (PCOs) focus on a patient’s beliefs, opinions, and needs, and are key to measuring and optimising the global transformation towards patient-centred healthcare. However, to what extent reimbursement agencies take PCOs into account when reviewing health technology assessment (HTA) submissions is unclear. Our client wanted to understand the impact of PCOs on HTAs submitted to the UK National Institute of Health and Care Excellence (NICE). They were particularly interested in the impact of PCOs other than quality of life as measured with the EuroQol-5D (EQ-5D). The answer had important implications for the client’s short- and long-term research and development strategy.

Our approach

Working together with the client, Symmetron developed a framework to analyse PCO impact in NICE HTAs. The framework included clinical and cost-effectiveness data, as well as barriers and facilitators of PCO impact mentioned by NICE or the manufacturer. We first conducted a pilot study on eight HTAs submitted to NICE and two HTAs submitted to the Scottish Medicines Consortium. We then applied the framework to a larger dataset of 69 publicly available NICE appraisals, of which 42 contained PCOs other than EQ-5D.

The outcome

Based on our analytical framework, PCO evidence had a substantial impact on NICE decision-making in 13/42 NICE appraisals, most often as part of the economic model.

Our analysis helped the client understand the current impact of PCOs in HTA submissions. These results provide general feedback on how PCO measures may be included in a company submission, which in turn could support a more favourable NICE assessment. Our findings were presented at the Health Technology Assessment International conference in June 2021 (PP42) and have been published in the International Journal of Technology Assessment in Health Care in December 2021.