A comparative study of drug listing recommendations and the decision-making process in Australia, the Netherlands, Sweden, and the UK

- Globally, there is growing interest in value-based decision-making in drug care.
- Agreement in drug listing is low, but is affected by appraisal and indication.
- Agreement in drug listing is biased downwards by low-value therapies.
- Discrepancies in listing reflect differences in appraisal and concern for value.

Drug listing recommendations from health technology assessment (HTA) agencies often fail to coincide with one another. We conducted a comparative analysis of listing recommendations in Australia (PBAC), the Netherlands (CVZ), Sweden (TLV) and the UK (NICE) over time, examined interagency agreement, and explored how process-related factors-including time delay between HTA evaluations, therapeutic indication and orphan drug status, measure of health economic value, and comparator-impacted decision-making in drug coverage. Agreement was poor to moderate across HTA agency listing recommendations, yet it increased as the delay between HTA agency appraisals decreased, when orphan drugs were assessed, and when medicines deemed to provide low value (immunosuppressants, antineoplastics) were removed from the sample. International differences in drug listing recommendations seem to occur in part due to inconsistencies in how the supporting evidence informs assessment, but also to differences in how domestic priorities shape the value-based decision-making process.