OBJECTIVES: The preferred approach to deriving utilities stated in the National Institute for Health and Care Excellence (NICE) guide to methods of technology appraisal is to apply preference values for the United Kingdom to EQ-5D data collected in relevant clinical trials. However, the methods used to derive utilities and incorporate them in economic models in appraisals have varied. This review examines how company and Evidence Review Group (ERG) utilities were derived, how they were applied for checkpoint inhibitors across oncology indications (e.g., health state, time to death, adverse-event decrements), and how the ERGs and appraisal committees critiqued these approaches.
METHODS: Published NICE appraisal documents—including company submission, ERG report, appraisal consultation(s), and final appraisal determination for checkpoint inhibitors across all oncology indications—were reviewed for each appraisal up to May 2020, and utility weight information was extracted and analysed from each, with comparisons made across indications and ERGs.
RESULTS: In total, 31 NICE appraisals were identified for the following checkpoint inhibitors: nivolumab (alone or in combination with ipilimumab; 10), ipilimumab (2), pembrolizumab (10), atezolizumab (5), avelumab (1), durvalumab (1), and blinatumomab (2). These products are approved in a wide variety of cancer types. The majority (29/31) of company models used utility values derived from clinical trials, according to the NICE reference case; however, these were often deemed implausibly high by the committees. However, the approach to adjusting these utility values was inconsistently applied by the committees for decision making.
CONCLUSIONS: This review provides insights into the most accepted approaches to derive and apply utility weights in immune checkpoint inhibitor oncology economic models developed for NICE appraisals. These results may be used to inform the utility weight methodology for use in future NICE submissions and will improve consistency of checkpoint inhibitor oncology appraisals going forward.
