New NICE guidance on how to appraise health technology

Posted on May 1, 2013 by

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NICE has revised its guidance on how to carry out a health technology assessment (HTA). This blog outlines some of the changes that are most relevant to medical research charities.

NHS organisations use new health technologies as part of research programmes, but these technologies only become available to all patients as part of routine care if they pass a technology appraisal. NICE (National Institute for Health and Care Excellence) technology appraisals are the way that new technologies are assessed to see if they are both clinically and cost effective.

Funders need to:

  • Ensure that the research they support will provide evidence that can be used in such an appraisal
  • Ensure they can feed in the patient perspective of perceived benefits at the scoping phase of appraisals
  • Look to the research recommendations and evidence gaps outlined in technology appraisals to inform their own strategic research funding decisions.

What is technology appraisal?

A new health technology is assessed over three stages to see whether it is clinically and cost effective for use in the NHS.

  1. Scoping: defines why an appraisal in needed, which patient group, what comparator technology. Patient groups should be involved in this process, ensuring that the views of patients on the perceived benefits of a technology are taken into account.
  2. Assessment: a systematic review of all research literature and a health economic assessment of the technology, carried out by an independent academic group. The assessment report on the strengths, weaknesses and gaps in the evidence. Charities can submit evidence to the appraisal, and will have funded the research that provides research evidence.
  3. Appraisal: the appraisal committee considers the evidence and makes a decision, applying judgements on a range of factors. This is guidance issued by NICE to the NHS. Clinical commissioning groups, NHS England and local authorities (for public health) have to comply with NICE technology appraisal recommendations within three months unless there are significant barriers (ref: The National Institute for Health and Care Excellence (Constitution and Functions) and the Health and Social Care Information Centre (Functions) Regulations 2013)

How does NICE judge that a technology is effective?

  • It is clinically effective if, in normal clinical practice, it confers a health benefit, taking account of any harmful effects and opportunity costs.
  • It is cost effective if its health benefits are greater than the opportunity costs of programmes displaced to fund the new technology, in the context of a fixed NHS budget.

What’s new in this guidance?

  1. NICE has defined a reference case of methods to assess cost effectiveness. This will ensure consistency between appraisals and allow.
  2. NICE has confirmed that it will include information from patients on the patient experience of living with the condition, having particular treatments, the outcomes that are important to patients, the acceptability of different treatments and patient perception of risk.
  3. NICE has defined how these patient narrative summaries need to be provided, to ensure they can be incorporated into the systematic review.
  4. NICE also wants patient groups to indicate if there are limitations to the current literature, or if inappropriate outcome measures have been used.

Patient groups can also comment on the relevance of outcome measures and economic evaluation tools outlined in the scoping document.

Posted in: Research