Variations in HTA outcomes can primarily be explained with reference to institutional context and administrative rules. Here we focus on the German Federal Joint Committee (Gemeinsamer Bundesausschuss, GBA), the French Haute Autorité de Santé (HAS) and the British National Institute for Health and Care Excellence (NICE) to identify matched drug pairs as a basis to compare HTA outcomes and to analyze cancer-related HTA results in detail.
Data were extracted from all published GBA resolutions from January 2011 – when the AMNOG legislation was introduced in Germany – to June 2018, as well as all publicly available HAS reports and NICE single technology appraisals during this period. We compared HTA outcomes of matched pairs overall, and separately for non-cancer and cancer drugs. Then, the potential role of additional attributes with regard to cancer drugs was explored, such as orphan drug designation in Germany, impact of reimbursement rates in France and consideration of end of life (EoL) criteria in England. The relationship between HTA outcomes and attributes was tested for statistical significance with a chi-square test or, if required, Fisher's exact test.
By pairwise comparison, HTA outcomes (cancer, 58/102; non-cancer, 44/102) showed higher congruence for GBA/HAS (total, 67%; cancer, 72%; non-cancer, 59%) than for GBA/NICE and HAS/NICE (total, 54%; cancer, 57%; non-cancer, 50%). NICE recommended 85/102 (cancer, 42/58; non-cancer, 43/44) technologies, whereas GBA and HAS reported added benefit for 72/102 (cancer, 49/58; non-cancer, 23/44) and 60/102 (cancer, 37/58; non-cancer, 23/44) medicines, respectively. When we tested NICE cancer recommendations for the consideration of EoL criteria, no significant impact was found (p>.05, Fisher's test). In contrast, GBA cancer appraisals are associated with an orphan designation (p<.05, chi-square test), and cancer-related findings for the HAS indicate that the reimbursement rate correlated with the assessment of clinical added value (p<.05, chi-square test).
Our results confirm that variations in HTA outcomes frequently exist. However, cancer-related HTA results seem to be less divergent compared to non-cancer results.
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All authors have declared no conflicts of interest.