NICE: 20% of Clinically Effective Drugs are not Reimbursed — Do You Want to Know Why?

Our industry leading platform, Reimbursement Risk Tracker™ (RRT) offers an insightful look into the complex and often confusing drug development process, specifically focusing on the behavior of Health Technology Assessment (HTA) agencies around the world.


The Snapshot above shows decision data based on 99 reviews from the United Kingdom’s National Institute for Health and Care Excellence (NICE). It clearly represents that for NICE, clinical efficacy/effectiveness is not always enough: a drug that works is not guaranteed a positive overall evaluation. Of the 99 NICE reviews represented above, 16 did not result in reimbursement, in spite of demonstrating greater efficacy/effectiveness than comparators. What made them different from the rest?


Price Matters!

By changing the search parameters, we can see that all 16 of these reviews were not reimbursed because NICE found them less cost-effective than comparators, despite greater efficacy/effectiveness. Most of the reviews that achieved reimbursement demonstrated greater or acceptable cost-effectiveness. Only one review showing lower cost-effectiveness resulted in reimbursement.

With our proprietary data platform, it was simple to find and read the details of the specific review to learn why only this one particular drug was reimbursed, despite its lower cost-effectiveness. It came from a 2006 review of efalizumab for Psoriasis. According to NICE, “Given that other treatment options available for these people were limited, the Committee concluded that efalizumab should be recommended for use in the group of people whose psoriasis had failed to respond to etanercept, or who were either intolerant of or had definite contraindications to, etanercept.”

Powerful Visualization, Breadth and Depth of Data

Our platform comprises health economics and outcomes research, and market access HTA data, along with other key datasets affecting drug development, including Regulatory and Clinical, and other contextual information.

Snapshots are charts that our customers use to save and share important insights from RRT. Snapshots provide a concise analytical view, aggregating reimbursement information across time, disease, companies, and agencies in the form of pie charts, bars, and maps for easy yet powerful analyses.

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