HTA monthly – April updates

Written by Kiera Lander & Oliver Burn

 

1 – A NICE modular update: adopting the EQ‑5D‑5L UK value set

 

What is changing (methods update)

• • The National Institute for Health and Care Excellence (NICE) is consulting on a modular update to adopt the EQ‑5D‑5L dataset as the default for reference‑case cost–utility analyses
  • The change reflects improved valuation methods, updated societal preferences, stronger governance, and independent quality assurance
  • NICE proposes to update:
    • • PMG36 and PMG20 (guideline manuals) to adopt EQ‑5D‑5L
      • 3L data will be mapped to the 5L value set, using Decision Support Unit (DSU)‑endorsed functions
  • The update will apply prospectively only; existing technology appraisals will not be reopened solely due to the value set change

Why it matters

• • The 3L value set is based on mid-1990 preferences, outdated population demographics, and older elicitation methods
  • Mapping from 5L to 3L has been a long debated methodological approach requiring an improvement, particularly for quality of life (QoL)‑improving (non‑life‑extending) technologies
  • Previous analyses on moving from 3L to 5L have shown that 5L shifts health state values higher and compresses them into a smaller range
  • Previous analyses in other markets showed reduced incremental quality-adjusted life years (QALYs) in most comparisons for the majority of countries moving from 3L to 5L, and differences in results could be large
  • NICE‑commissioned impact assessments show that the new direction may favour therapies in some indications such as oncology, or therapies that extend life, while disadvantaging therapies that improve QoL:
    • • Cancer medicines generally become more cost effective (median incremental cost effectiveness ratio [ICER] reduced by ~12%)
      • Non‑cancer, QoL‑only treatments often become less cost effective (median ICER increased by ~59%), noting small samples and high ICER sensitivity
      • Life‑extending non‑cancer treatments show mixed but generally modest effects
  • Severity weighting is unlikely to change in most appraisals, as proportional shortfall drives outcomes more than absolute shortfall

What this means/impact

• • Evidence generation and modelling strategy
    • • Stronger case for collecting EQ‑5D‑5L directly in trials and real‑world studies
      • Early consideration of whether EQ‑5D remains appropriate in certain populations (and when alternative measures may still be needed)
      • Expect greater scrutiny of incremental QALY drivers, especially where benefits are primarily QoL‑based
      • Pricing, confidential discounts, and cost offsets become even more critical where QALY gains are small

2 – Carer HRQoL in NICE guidance

 

What it is

• • NICE’s health technology evaluations manual (Section 4.3.17) allows carer health effects to be included in the reference case, stating that outcomes should capture “all health effects, whether for patients or, when relevant, carers”
  • Despite this, the current manual provides minimal practical guidance on when and how to incorporate carer health‑related quality of life (HRQoL) in economic evaluations
  • During the methods review underpinning the current manual, carer HRQoL was explored by a NICE task and finish group, but it was concluded that the evidence base at the time was insufficient to support detailed methodological guidance

Why it matters

• • From a health technology assessment (HTA) perspective, the absence of clear methods guidance has led to inconsistent submissions and variable committee treatment of carer HRQoL across appraisals
  • For health economics and outcomes research (HEOR) teams, this creates uncertainty over:
    • • Whether inclusion of carer HRQoL will be viewed as appropriate
      • What types of evidence and modelling approaches are considered acceptable
  • These challenges are particularly relevant in disease areas with high carer burden, where carer impacts may be substantial but difficult to justify consistently without clearer NICE expectations

What it means/impact

• • For HEOR and HTA strategy, this suggests a potential shift towards:
    • • More consistent expectations for evidence submission
      • Clearer grounds for committee acceptance or rejection of carer HRQoL
      • Earlier consideration of carer impacts within evidence generation and model design to reduce appraisal risk

3 – The UAE HTA update

 

What it is

• • The United Arab Emirates (UAE) is formalising HTA at Emirate level, with Abu Dhabi leading via the introduction of formal HTA guidelines in 2025 by the Department of Health (DoH) and supporting commentary from Windrose Consulting Group
  • The Abu Dhabi HTA framework applies to innovative and high‑cost technologies, including pharmaceuticals, biologics, gene therapies, medical devices and digital health, and evaluates clinical effectiveness, economic value, and budget impact
  • There is currently no unified national HTA system, although parallel academic and policy initiatives indicate growing interest in broader HTA institutionalisation across the UAE

Why it matters

• • Narrative: The Abu Dhabi framework represents a shift from price‑led access to value‑based assessment, increasing the importance of structured HEOR evidence for reimbursement and coverage decisions
  • Budget impact focus: Compared with NICE, the Abu Dhabi HTA process places greater weight on budget impact, with cost‑effectiveness assessed flexibly rather than against a single explicit threshold
  • Timelines: Short appraisal timelines (around 30–60 days) heighten the importance of early engagement and well‑prepared submissions

What it means/impact

• • Economic models and access strategy need to be tailored at a local level, with clear articulation of affordability, budget impact, and value relative to local care pathways
  • While convergence towards a broader, potentially national HTA system is plausible over time, fragmentation remains a key near‑term risk for planning and execution (see Frontiers analysis)

 

If you would like to learn more about HTA submissions (including strategy planning, systematic reviews, health economic modelling, and medical writing), please contact us at Source Health Economics, an independent consultancy specialising in evidence generation, health economics, and communication.