Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, with reference to the forthcoming analysis by the National Institute for Health and Care Excellence of the effectiveness of the use of CAR-T therapy for multiple myeloma, which national tariffs NICE will use for that analysis; how those tariffs were calculated; which (a) people and (b) organisations were consulted on the calculation of the tariff; and which tariffs were used by NICE in analysis of the use of CAR-T therapy for other conditions.

The National Institute for Health and Care Excellence (NICE) is currently evaluating ciltacabtagene autoleucel, a type of CAR-T therapy, within its marketing authorisation for relapsed or refractory multiple myeloma. NICE has previously evaluated other CAR-T therapies such as axicabtagene ciloleucel (Yescarta®) and tisagenlecleucel (Kymriah®) through its technology appraisal programme.

NICE’s technology appraisal process requires the manufacturer or sponsor of the technology under evaluation to produce an evidence submission that is developed in line with NICE’s preferred methods for economic evaluation (the “reference case”) as set out in its published manual for health technology evaluation. The evidence submission is then considered by NICE’s appraisal committee alongside a critique from an independent academic group and evidence from other stakeholders such as patients, clinicians and NHS England. During the ongoing appraisal of axicabtagene ciloleucel for treating relapsed or refractory follicular lymphoma, NHS England made the committee aware of a single tariff for the delivery of CAR T-cell therapies. NICE does not hold any information on who NHS England consulted on the calculation of the tariff.

NICE’s health technology evaluation manual states that the reference case “should include the full additional costs associated with introducing a technology”. The appraisal committee will consider in developing its recommendations whether the costs that are captured in the evidence submission appropriately reflect the costs to the National Health Service.

The committee papers for previous and ongoing appraisals of CAR-T therapies are available on the NICE website.