Is the National Institute for Health and Care Excellence (NICE) in England more ‘innovation-friendly’ than the Federal Joint Committee (G-BA) in Germany?

ABSTRACT

Objectives: Our study explores whether, and how, different methodological choices are associated with different health technology assessment (HTA) outcomes. We focus on the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA) in Germany and the National Institute for Health and Care Excellence (NICE) in England. Both agencies may be considered as exemplars for the application of the principles of evidence-based medicine and the logic of cost-effectiveness, respectively.

Methods: We extracted data from all publically available G-BA appraisals until April 2015, as well as all NICE single technology appraisals completed during this period. We compared HTA results for matched condition-intervention pairs by G-BA and NICE, and explored other factors including therapeutic area, clinical effectiveness and cost-effectiveness.

Results: NICE issued guidance for 88 technologies (125 subgroups) and recommended 67/88 technologies (99/125 subgroups). G-BA completed 105 appraisals (226 subgroups) and determined additional benefit for 64/105 appraisals (90/226 subgroups). We identified 37 matched pairs; for 24/37 drugs, evaluations diverged. NICE recommended 78% (29/37) of technologies appraised, whereas G-BA confirmed additional benefit for 57% (21/37) only (p < 0.05).

Conclusions: NICE evaluates new drugs more favorably than G-BA. However, our analysis suggests differences by therapeutic area. Results indicate that different methods are associated with systematic differences in HTA outcomes.

KEYWORDS:

• Condition-intervention pair
• early benefit assessment
• evaluation
• health technology assessment
• single technology appraisal

Acknowledgments

The authors thank Prof. Oliver Schwarz and Dr. Diego Hernández for their support with statistical analysis, as well as Erica Niebauer for editing and proof-reading the manuscript.

Author contribution statement

The research design was developed as a combined effort of all authors. Data extraction as well as descriptive analysis was performed by RS under the supervision of MS. The initial manuscript was drafted by RS and revised by MS. All authors approved the final version to be published; and agree to be accountable for all aspects of the work.

The contribution represents original work that has not been previously published or simultaneously submitted for publication elsewhere.

Data availability statement

The data that support the findings of this study are available from the corresponding author, RS, upon reasonable request.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was not funded.