A nice (pun intended) paper by Thokala et al. (2020) compares the Institute for Clinical and Economic Review (ICER) with the National Institute for Health and Care Excellence (NICE) along 4 dimensions: structure, methods, process, and use in decision-making. While ICER and NICE methods are fairly similar, ICER is a non-governmental body without any explicit decision-making power; NICE is a governmental body with decision-making power due to the UK’s single payer system. A more detailed comparison of their methods are below.

Thokala et al. (2020)

The organizations also differ in terms of how much they value innovation versus cost savings.

NICE typically uses a threshold of £20,000-£30,000 per QALY, with a threshold of £50,000 per QALY for technologies that meet end of life criteria,41 and a higher threshold of between £100,000 and £300,000 per QALY when appraising technologies for rare diseases. ICER uses $100,000 and $150,000 per QALY to estimate the value-based price benchmarks (recently renamed as health benefit price benchmarks) and provides incremental results up to $200,000 per QALY and per equal value of life years gained (evLYG).

Timing also differs. NICE evaluations typically take place 12-14 months after UK marketing authorizations whereas ICER starts their reviews 8 months prior to FDA approval.

Recommendations also differ. NICE is limited to only 5 recommendations types: (i) recommended, (ii) optimized, (iii) recommended for use in the Cancer Drugs Fund (cancer appraisals only), (iv) only in research, or (v) not recommended. ICER provides a value-based drug price and recommended discounts as well as their full report, but it’s up to individual payers of how they incorporate that evidence into their price and coverage negotiations.


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