Now you see it, now you don’t. Survival data is clearly shown in the German and French reports, but is heavily blacked out in the UK assessments. Why so mysterious?
The author of a new HealthWatch-funded research study has called for more openness in the way new health treatments are assessed by the UK’s National Institute for Clinical Excellence (NICE).
The study, by Till Bruckner of TranspariMED, Bristol, looked at how transparently the effectiveness of a new breast cancer drug – palbociclib (brand name Ibrance) – was assessed by three different European health technology assessment agencies (HTAs).
Why is transparency in HTA assessment important?
Health technology assessment agencies evaluate all new drugs, medical devices and treatments to see if they are clinically better than other treatments currently in use for the patient group in question. New is not always better. So, if NICE decides that a new treatment adds little or no value, the NHS is unlikely to pay for patients to receive it. This is important to avoid patient harms or wasting money. Transparency over HTA decisions reduces the risk of corruption, furthers medical progress, and enables democratic debates on public health priorities and allocation of public resources.
What did the study find?
Overall, NICE does a very good job. NICE (England & Wales), IQWIG (Germany) and HAS (France) all did well at disclosing who reviewed the evidence underlying their assessments, and how possible conflicts of interest were managed. They also detailed what evidence they reviewed, and how they evaluated it. The literature suggests that many other European HTAs do not meet these high transparency standards.
However, in some places NICE used redactions to obscure efficacy data from its drug assessment reports; disclosure of similar data by HAS and IQWIG shows that such redactions are not inevitable. Bruckner calls on NICE to stop redacting clinical trial data and follow the positive example of its German counterpart. “NICE must also to follow up on its recent pledge to take into account concerns about undisclosed industry funding for patient groups in the ongoing review of its conflict of interest policies.”
Concluding, Bruckner says HTAs should raise the bar on transparency by matching or exceeding the strongest transparency policies and practices of the individual Member State that is most advanced in that area. Notably, European-level HTAs should adopt IQWIG’s approach of routinely publishing all clinical trial data used within its assessment reports.
- The study was the work of Till Bruckner of TranspariMED. TranspariMED uses research-driven advocacy to fight distortion in the clinical evidence base, that results from failure to register and fully report clinical trials. TranspariMED develops and promotes policy solutions for greater transparency in health.
- This research study, which is published Open Access (CC-BY 4.0), was made possible with a grant from HealthWatch, the UK charity the promotes science and integrity in healthcare.
- Applications are invited for funding tranches of up to £10,000 to support further research projects that meet the aims and objectives of HealthWatch. There is no closing date. Click here to find out more and how to apply. The HealthWatch Research Fund is independent of industry and has no financial interest in any form of healthcare.
- Reference Bruckner T. Transparency in health technology assessment: NICE, IQWIG and HAS in comparison. Published 2 March 2020 by HealthWatch, and made available under a CC-BY 4.0 International License. https://www.healthwatch-uk.org/HTA.pdf