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Evaluating new technologies – the case for change


11 November 2020
Our chief executive, Gillian Leng.
Dear <<First name>>,

NICE has carried out a comprehensive review of the methods used for health technology evaluation, covering medicines, highly specialised technologies, devices and diagnostics. These methods are regarded by many as the global gold standard in health technology assessment. They underpin the robust, consistent and transparent decision-making on which we base our guidance and are pivotal in securing rapid and fair access for patients to clinically and cost-effective interventions. They inform some of the most difficult decisions taken in public life, influencing the care received by millions of people. 

Since March 2000, we have published over 600 technology appraisals. During that time, the methods we’ve used have regularly evolved. We have conducted a series of major methods updates over the years, with iterative improvements in between, ensuring our methods remain relevant and responsive to developments and innovations in the life sciences industry.

Key milestones

In 2009, we issued supplementary ‘end of life’ guidance for technologies that may extend the life of people with a very short life expectancy. This ‘modifier’ means that in certain circumstances, treatments for patients at the end of life can exceed our normal cost effectiveness threshold. 

In January 2016, we incorporated the Cancer Drugs Fund (CDF) into our methods, following a request from NHS England. This significant development meant we could recommend a drug with uncertain cost effectiveness for use within the CDF, so patients could benefit while more information was gathered on its effectiveness. This has allowed our committees to approve more cancer drugs than previously, increasing the number of positive cancer drug appraisal recommendations by 15%.

More recently, in April 2017, we introduced a budget impact test to help the adoption of new technologies into the NHS in a financial sustainable way. The test assesses the financial impact of a technology over the first 3 years of its use in the NHS. 

To facilitate the approval of new drugs and technologies, we have also changed the way we work. We now engage with companies earlier in the process to influence the research agenda, and work closely with partner organisations involved in regulation. 

Downstream from the technology appraisal process, we work with NHS England and companies to ensure opportunities are in place to carefully manage the entry of innovative new technologies into the NHS.
The consultation document includes a proposal for removing the current modifier for life-extending treatments at the end of life and suggests adding alternative modifiers for disease severity and health inequalities.

The case for change

Our methods aim to reconcile the aspirations of patients, health professionals and life sciences companies with the resources available to the NHS. Rapid changes in the healthcare system and the field of technology evaluation, mean a wide-reaching review of our methods has been both appropriate and timely. 

Innovations such as personalised medicine, digital health technologies and cell therapy mean products are becoming more complex to evaluate. And there is increasing demand to make treatments available more quickly, sometimes with a lower evidence base than was previously the case. 

The consultation document includes a proposal for removing the current modifier for life-extending treatments at the end of life and suggests adding alternative modifiers for disease severity and health inequalities.  We also propose accepting a greater degree of uncertainty and risk in some circumstances, for example for innovative treatments or for conditions where evidence generation is complex and difficult, such as rare diseases.

Our methods review consultation is open until Friday 18 December. So, please do take the opportunity to review the proposals and let us have your comments. We are also holding a consultation event on Wednesday 25 November 2020, 4pm to 5pm. We'll be discussing the proposals and answering any questions.  
 
Comment on our methods review consultation
Gillian Leng CBE
Chief executive, NICE
 
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