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The evolving nature of Health Technology Assessment: a critical appraisal of NICE’s new methods manual

Angelis, Aris ORCID: 0000-0002-0261-4634, Harker, Martin, Cairns, John, Seo, Mikyung Kelly, Legood, Rosa, Miners, Alec, Wiseman, Virginia, Chalkidou, Kalipso, Grieve, Richard and Briggs, Andrew (2023) The evolving nature of Health Technology Assessment: a critical appraisal of NICE’s new methods manual. Value in Health, 26 (10). 1503 - 1509. ISSN 1098-3015

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Identification Number: 10.1016/j.jval.2023.05.015


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.

Item Type: Article
Official URL:
Additional Information: © 2023 The Author(s)
Divisions: Health Policy
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
T Technology > T Technology (General)
Date Deposited: 07 Jun 2023 15:54
Last Modified: 15 Jul 2024 00:54

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