The Evolving Nature of Health Technology Assessment: A Critical Appraisal of NICE's New Methods Manual

Aris Angelis; Martin Harker; John Cairns; Mikyung Kelly Seo; Rosa Legood; Alec Miners; Virginia Wiseman; Kalipso Chalkidou; Richard Grieve; Andrew Briggs

doi:10.1016/j.jval.2023.05.015

The Evolving Nature of Health Technology Assessment: A Critical Appraisal of NICE's New Methods Manual

Value Health. 2023 Oct;26(10):1503-1509. doi: 10.1016/j.jval.2023.05.015. Epub 2023 Jun 1.

Authors

Affiliations

¹ Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, England, UK; Department of Health Policy and LSE Health, London School of Economics and Political Science, London, England, UK. Electronic address: aris.angelis@lshtm.ac.uk.
² Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, England, UK.
³ Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, England, UK.
⁴ Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, England, UK; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Department of Surgery and Cancer, Imperial College London, London, England, UK.
⁵ Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, England, UK.
⁶ School of Public Health, Imperial College London, London, England, UK.

PMID: 37268059
DOI: 10.1016/j.jval.2023.05.015

Abstract

Objectives: The National Institute for Health and Care Excellence (NICE) recently completed a review of its methods for health technology assessment, involving a 2-stage public consultation. We appraise proposed methodological changes and analyze key decisions.

Methods: We categorize all changes proposed in the first consultation as "critical," "moderate" or "limited" updates, considering the importance of the topic and the degree of change or the level of reinforcement. Proposals were followed through the review process, for their inclusion, exclusion, or amendment in the second consultation and the new manual.

Results: The end-of-life value modifier was replaced with a new "disease severity" modifier and other potential modifiers were rejected. The usefulness of a comprehensive evidence base was emphasized, clarifying when nonrandomized studies can be used, with further guidance on "real-world" evidence developed separately. A greater degree of uncertainty was accepted in circumstances when evidence generation raised challenges, in particular for children, rare diseases, and innovative technologies. For some topics, such as health inequality, discounting, unrelated healthcare costs, and value of information, significant changes were possibly warranted, but NICE decided not to make any revisions at present.

Conclusion: Most of the changes to NICE's health technology assessment methods are appropriate and modest in impact. Nevertheless, some decisions were not well justified and further research is needed on several topics, including investigation of societal preferences. Ultimately, NICE's role of protecting National Health Services resources for valuable interventions that can contribute toward improving overall population health must be safeguarded, without accepting weaker evidence.

Keywords: Health Technology Assessment (HTA); NHS England; National Institute for Health and Care Excellence (NICE); economic evaluation; methods development; technology evaluation.

MeSH terms

Child
Cost-Benefit Analysis
Health Status Disparities*
Humans
Technology Assessment, Biomedical*
Uncertainty
United Kingdom