Incremental benefits of novel pharmaceuticals in the United Kingdom 61 4♣ Submi ed Technology Appraisals N = 436 Documented Technology Appraisals N = 321 QALY esmated N = 265 Retrieved QALY es mates N = 184 No documentaon available N = 115 - Terminated N = 56 - Withdrawn N = 14 - Reconsidered N = 45 No QALY reported N = 56 - Negave coverage decision N = 37 - Unable to determine most plausible QALY N = 11 - Cost-saving Technology Appraisals N = 8 QALY esmate redacted by manufacturer N = 81 Figure 3: Flow diagram of the selection and retrieval of estimates of Quality-Adjusted Life Years (QALYs) from NICE technology appraisals between January 1st, 2010 and December 31st, 2020. Each appraisal was categorized according to its medical discipline: cardiology, endocrinology, gastroenterology, hematology, neurology, oncology, ophthalmology, rheumatology, vascular medicine, infectious diseases and other (benign hematology, dermatology, internal medicine, nephrology, psychiatry, pulmonology, urology). Summary statistics were calculated and visualized in R version 4.0.5. RESULTS Between January 1st, 2010 and December 31st, 2020, 436 single technology appraisals were submitted to NICE associated with 212 drugs. No documentation was available for 115 appraisals, including 14 that were withdrawn, 56 that were terminated, and 45 that were later reconsidered or updated. Another 37 appraised drug-indication pairs received a negative reimbursement determination, meaning they were not considered a cost-effective use of NHS resources and thus did not become available to patients in the UK. An estimate of QALY gain could not be extracted in 19 appraisals, because QALYs were not reported in cost-saving appraisals or because the evidence review group did not specify its preferred estimate out of several reported outcomes. After these exclusions, 265 appraisals were available for evaluation, associated with 171 drugs. Of these appraisals, 81 had their incremental QALY estimates redacted (Supplementary Material),
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