Bell Gorrod, H. orcid.org/0000-0001-8054-8073, Kearns, B. orcid.org/0000-0001-7730-668X, Stevens, J. orcid.org/0000-0002-9867-7209 et al. (5 more authors) (2019) A review of survival analysis methods used in NICE technology appraisals of cancer treatments: consistency, limitations and areas for improvement. Medical Decision Making, 39 (8). pp. 899-909. ISSN 0272-989X
Abstract
Objectives: In June 2011, the National Institute for Health and Care Excellence (NICE) Decision Support Unit published a Technical Support Document (TSD) providing recommendations on survival analysis for NICE technology appraisals (TAs). Survival analysis outputs are influential inputs into economic models estimating the cost-effectiveness of new cancer treatments. Hence, it is important that systematic and justifiable model selection approaches are used. This study investigates the extent to which the TSD recommendations have been followed since its publication.
Methods: We reviewed NICE cancer TAs completed between July 2011 and July 2017. Information on survival analyses undertaken and associated critiques for overall survival (OS) and progressionfree survival were extracted from the company submissions, Evidence Review Group (ERG) reports and final appraisal determination documents.
Results: Information was extracted from 58 TAs. Only four (7%) followed all TSD recommendations for OS outcomes. The vast majority (91%) compared a range of common parametric models and assessed their fit to the data (86%). Only a minority of TAs included an assessment of the shape of the hazard function (38%) or proportional hazards assumption (40%). Validation of the extrapolated portion of the survival function using external data was attempted in a minority of TAs (40%). Extrapolated survival functions were frequently criticised by ERGs (71%).
Conclusions: Survival analysis within NICE TAs remains sub-optimal, despite publication of the TSD. Model selection is not undertaken in a systematic way resulting in inconsistencies between TAs. More attention needs to be given to assessing hazard functions and validation of extrapolated survival functions. Novel methods not described in the TSD have been used, particularly in the context of immuno-oncology, suggesting that an updated TSD may be of value.
Metadata
Item Type: | Article |
---|---|
Authors/Creators: |
|
Copyright, Publisher and Additional Information: | © 2019 The Authors. This is an author-produced version of a paper subsequently published in Medical Decision Making. Uploaded in accordance with the publisher's self-archiving policy. Article available under the terms of the CC-BY-NC-ND licence (https://creativecommons.org/licenses/by-nc-nd/4.0/). |
Keywords: | cancer; extrapolation; health technology assessment; survival analysis; technology appraisal |
Dates: |
|
Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 26 Sep 2019 08:06 |
Last Modified: | 29 Apr 2021 13:07 |
Status: | Published |
Publisher: | SAGE Publications |
Refereed: | Yes |
Identification Number: | 10.1177/0272989X19881967 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:150868 |
Download
Filename: A review of survival analysis methods used in NICE technology appraisals of cancer treatments.pdf
Licence: CC-BY-NC-ND 4.0