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INSIGHTS | INDIRECT TREATMENT COMPARISONS
TABLE 1: PAYER/HTA PERSPECTIVE ON INDIRECT COMPARISONS IN KEY MARKETS
COUNTRY PAYER/HTA PERSPECTIVE ON INDIRECT COMPARISONS
Belgium KCE
Canada CADTH
France HAS
Germany IQWiG
Netherlands CVZ
Scotland SMC
Sweden TLV
UK NICE
KEY
CADTH: Canadian Agency for Drugs and Technologies in Health
CVZ: College Voor Zorgverzekeringen
HAS: Haute Autorité de Santé
IQWiG: Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen
Indirect comparisons are only allowed under specific conditions: the
choice of an indirect instead of direct head-to-head comparison
between study treatment and comparator should be explained, and
limitations of the indirect comparison described. 2
No formal guidance but best practices outlined by ISPOR and NICE
should be considered for submissions.
Methodological guide, Oct 2011, states:”If direct comparative data
are not available or are insufficient, it may be necessary to perform
indirect comparisons according to validated methodologies”. Offers
two techniques: simple adjusted indirect comparison (straightforward
and transparent); and network Bayesian methodology (provides best
solution to determine hierarchy of treatment pathways). 3
Recognizes methods supported by NICE. Stares that indirect
comparisons can be considered useful, necessary and inevitable in
some cases. However, also claims that results based on indirect
comparisons are associated with more uncertainty than
direct comparisons. 4
Allows use of indirect comparisons while recognizing that this type
of evidence is less valuable than direct comparisons. 5
Guidance notes (2012) stipulate requirement for indirect comparisons
if head-to-head evidence is not available. 6
No published statement on indirect comparisons but in evaluations of
reimbursement dossiers, TLV has been pragmatic, evaluating on a
case-by-case basis. The use of MTC and indirect comparisons has been
accepted when well supported and scientifically robust.
NICE guidance states:
“Data from head-to-head RCTs should be presented in the referencecase
analysis, if available. When head-to-head RCTs exist, evidence
from mixed treatment comparison analyses may be presented if it is
considered to add information that is not available from the head-tohead
comparison.” “If data from head-to-head RCTs are not available,
indirect treatment comparison methods should be used.” “There may
be circumstances in which data from head-to-head RCTs are less than
ideal (for example, the sample size may be small or there may be
concerns about the external validity). In such cases additional
evidence from mixed treatment comparisons can be considered.” 7
KCE: Federaal Kenniscentrum voor de Gezondheidszorg
NICE: National Institute for Health and Clinical Excellence
TLV: Tand-och Lakemedelsformansverket
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