Approaches to utility value assessment in NICE technology appraisals of targeted therapies for non-small-cell lung cancer: a critical examination and recommendations

OBJECTIVES: The aim of this study is to evaluate the application, methodology and consistency of utility values used in National Institute for Health and Care Excellence (NICE) single technology appraisals (STAs) of targeted therapies for advanced or metastatic non-small-cell lung cancer (NSCLC) over the past decade. METHODS: A review was conducted of NICE STAs of NSCLC targeted therapies from 2012 to 2022, focusing on four key aspects: (1) utility values per health state as defined by the economic model structure; 2) the primary sources of these utility values; (3) the methods used to derive utilities for quality of life, and 4) the application of disutilities or utility decrements. RESULTS: In the included 16 appraisals for targeted therapies, substantial variation was identified in the application, methodology, and consistency of utility values used in CUAs appraised by NICE over the past decade. Most appraisals used health state-specific utilities, with progression free values primarily derived from clinical trials and progressed disease values more often derived from external literature. Disutilities for adverse events were applied in an inconsistent way and no stratification by age was reported. CONCLUSION: Enhancing methodological consistency and incorporating up-to-date, representative utility data, particularly for progressed disease and adverse events, would strengthen the robustness, transparency and comparability of NICE technology appraisals of targeted therapies in NSCLC.