Health Technology Assessment

Having supported our clients with over 80 health technology assessment (HTA) submissions, our dedicated HTA team are the experts when it comes to devising the optimal strategy and delivering the highest quality dossiers. Our experience predominately lies with NICE, SMC, AWMSG and NCPE in Europe, and the Agency for Care Effectiveness (ACE) in Singapore. In addition to submission development, our HTA team has experiencing in delivering high quality early HTA feasibility assessments, global HTA dossiers, NICE Scientific Advice briefing books, ACE topic selection forms, AMCP dossiers and health economic publications.

Health Technology Assessment

What makes HTA and Health Economic writing at Costello Medical different?

High quality writing support

Our experience in clinical trial communication, coupled with our thorough training in health economics from the University of York, makes us ideally placed to seamlessly weave together the clinical and economic stories within your HTA submission, global HTA dossier or health economic publication and develop an evidence-based, persuasive and clear strategic narrative.

Exceptional customer service

We genuinely care about our clients’ HTA submissions and health economic publications as much as they do. We aim to become an integral part of the client team, providing technical expertise and the highest quality writing alongside proactive and responsible project management support.

Provision of strategic advice

We are experienced in advising clients on wide-ranging strategic HTA challenges, such as off-label comparators, lack of randomised trial evidence and immature data. We also provide guidance on responding to competitor appraisals, conduct strategic analyses of prior submissions and gather specialist advice through clinical and economic advisory boards or expert surveys.

A comprehensive HTA solution

We work as one internal team to deliver all components of your HTA submission, including the systematic reviews, the network meta-analyses, the health economic models and the written submission. We firmly believe that in doing so we can offer a solution that is not only more efficient, but that also results in a strong, consistent and self-reinforcing HTA story throughout the submission.

Case Studies

Complete HTA Support

We supported a small pharmaceutical company with their complete NICE and SMC submissions for a new product that they were bringing to market, including the systematic literature reviews, the network meta-analysis, the economic model development and the written submissions. We were able to advise the client on how best to present the benefits of their product within the clinical pathway, particularly given that there were issues with off-label use of other comparators and few randomised controlled trials in the disease area.

Due to her detailed knowledge of the submission, the manufacturer asked the Costello Medical project manager to be one of the manufacturer representatives at the NICE Committee meeting. The persuasive narrative within the submission coupled with the comprehensive statistical analysis that had been performed persuaded NICE to approve the new technology after just one Committee meeting.

NICE Response

We were approached by the global market access division of a large pharmaceutical company requiring urgent assistance in drafting their response to a Technology Assessment Review (TAR) issued by the NICE in the UK.

The report issued recommendations that misrepresented their product’s clinical efficacy and cost-effectiveness and would have been highly damaging to market access success globally if adopted in NICE’s final guidance. The NICE consultation and review process provided an opportunity for the pharmaceutical company to submit a response to the TAR.

As we had not been involved in the original NICE submission and tight deadlines are imposed during the consultation phase, we had to assimilate and evaluate in a matter of days an unfamiliar report of over 500 pages issued by the academic group commissioned by NICE. This report was highly complex because our client’s product had been assessed alongside a number of others in the same therapeutic area. Our detailed analysis of the clinical and economic data presented in the TAR helped to identify the inappropriate interpretation of the clinical evidence by the academic group as well as serious flaws in their approach to the economic model.

Drawing on these findings, we agreed the strategy for the response in close collaboration with our client’s market access team. We then swiftly drafted a targeted and persuasive, yet respectful, document for submission to NICE, which successfully influenced their decision-making process: the evaluation in the original version of the TAR, stating that our client’s product should not be considered cost-effective, was reversed in the final NICE guidance where it is now recommended for use in a key patient subgroup throughout England’s National Health Service.

ACE Full Evaluation Submission

We were requested to produce a full evaluation submission document for submission to the Agency of Care Effectiveness (ACE) in Singapore, for one of the first manufacturer submissions under the new HTA process. This was prior to the publication of the ACE process guidance or any appraisal documents, thus requiring us to use our background in UK HTA to best support our client. Complicating the submission further, the evaluation considered two different competing products from the same manufacturer against four competitor products, in a crowded indication with clear standards of care already well-entrenched.

We responded by working with the global, regional, and local medical, HEOR, and commercial teams to develop a strategy based on previous HTA experience and local priorities in Singapore. We attended all meetings with ACE to support the manufacturer and ask appropriate questions in order to advise on a practical approach to the submission, making use of existing materials, and understanding the decision drivers for ACE. We developed a budget impact model and conducted interviews with key opinion leaders to provide inputs for the model, as well as understanding the unmet need and the changes that would occur in local clinical practice with the introduction of these treatments. We also provided support to the commercial team on pricing scenarios, including possible competitor pricing strategies, and completed a thorough write-up of the full evaluation submission document comprising sections on the unmet need, the place in therapy, clinical effectiveness, cost-effectiveness and budget impact of the therapies.

Guidance documents published on the ACE website in July 2018 recommended that both products from our client were to be listed for subsidy on the Standard Drug List, the list of drugs assessed to be cost-effective and essential to the provision of medical care to all Singaporeans.

Singapore Topic Selection Dossier and Strategic Support

We were approached by the local team of a pharmaceutical company in Singapore requiring assistance in producing a dossier for topic selection by the Agency for Care Effectiveness (ACE).

We sought to highlight the unmet clinical need in this disease area to encourage evaluation by ACE. To do this, we conducted interviews with local clinical experts to support the arguments and gain more of an understanding about the extent to which there is adequate treatment in local clinical practice. In addition, the interviews provided us with local inputs for the simple budget impact model that we built to accompany the dossier. The presence of biosimilars in the market introduced certain complexities, but we used our experience across a variety of ACE submissions, and information obtained from communications with ACE, to support the client in developing a suitable biosimilar defence strategy, while providing a compelling case to ACE. We developed a suite of materials for the client, including an economic model, a topic selection dossier, and summary slides for presentation. The decision is expected by Q4 2018.

Articles and Publications

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