HTA’d in the USA: A Comparison of ICER in the United States with NICE in England and Wales

BACKGROUND: The Institute for Clinical and Economic Review (ICER) has gained recognition for performing independent health technology assessments (HTAs) that include the cost-effectiveness of selected new technologies in the United States. ICER has similarities with the National Institute for Health and Care Excellence (NICE) in England and Wales, but the amount of overlap and new methods adopted to meet stakeholder needs in the complex U.S. health care system have not been fully analyzed. OBJECTIVE: To perform a comprehensive comparison of ICER and NICE. METHODS: We compared ICER and NICE using the same framework as Drummond et al. (2008), which suggests 4 dimensions for comparison of HTA organizations: structure of HTA programs, methods of HTA, processes for conduct of HTA, and use of HTAs in decision making. RESULTS: We found differences between ICER and NICE in the structure of HTA programs (setup of the organizations, governance issues, and funding); methods (perspective, costs, utilities, discounting, and thresholds); process (relationship with relevant stakeholders, deliberative decision-making processes, and timelines); and the use of HTA in decision making (the format and type of evidence generated, how the evidence is considered, and the format of the recommendations). CONCLUSIONS: ICER uses a different approach for clinical review but performs cost-effectiveness analysis using methods similar to NICE. The key differences between NICE and ICER arise because of important differences between the United Kingdom’s “single payer” health care system and the United States’s pluralistic system. ICER’s lack of mandatory power translates to substantial differences in terms of its processes and type of recommendations.