Commissioning and adoption - Health technology evaluation

Assessments of health technologies are carried out by regulatory organisations in England, Scotland and Wales. The evaluations carried out by these organisations are considered equivalent.

In England, evaluations are carried out by the NICE Centre for Health Technology Evaluation (CHTE) which produces guidance for NHS England on the use of new and existing treatments such as medicines, medical devices and surgical procedures. In Scotland, this role is carried out by the Scottish Health Technologies Group (SHTG) which advises NHS Scotland, while NHS Wales is advised by Health Technology Wales (HTW), although HTW does not review medicines. In Northern Ireland, Health and Social Care NI reviews guidance provided by NICE and the technology’s suitability for use in Northern Ireland.

The health technology evaluation process includes the evaluation of clinical, economic and other types of evidence about the use of the innovation or existing treatments.

NICE provides a range of guidance and advice, including:

health technology guidance (HTG) assesses medical technologies to determine whether they are cost-effective, improve patient quality of life and patient treatment choice. HTG covers diagnostics, medical devices and digital technologies, including those that use AI. Where multiple technologies assessing a similar area are available, a single HTG will assess all these technologies
interventional procedures guidance assesses whether new or significantly modified interventional procedures are effective and safe enough for use in the NHS. Interventional procedures include those that make an incision, puncture or entry into a body cavity, or use ionising, electromagnetic or acoustic energy. The guidance for an interventional procedure focuses on the procedure, even if a piece of medical device is used, for instance if the device is implanted
highly specialised technologies guidance assesses technologies and medicines that are intended for people with ultra rare conditions that are likely to be very expensive. Most of the evaluation topics are chosen by the National Institute for Health Research Innovation Observatory. Each evaluation in this programme can cover only a single technology for a single indication
technology appraisal guidance assesses medicines and other innovations that cannot be assessed in the other types of NICE guidance. This programme uses a range of processes, including cost comparison, rapid review, multiple technologies comparison and appraisal of a single technology for multiple indications
early use assessments look at new technologies which could address a national unmet need but may still require further evidence before they are ready for a full assessment. Recommended technologies must then meet an agreed evidence generation plan to support this full assessment. Key to this approach is managing all risks associated with the medical device during the evidence generation period while generating the information needed for NICE to make a recommendation about the routine use of the technology
existing use assessments compare multiple products which are already in use within the NHS in a particular product category. The existing use stage assessment looks at the value for money and performance claims of each device and takes account of any incremental improvements which may have taken place since the technology’s approval

NICE prioritises specific clinical and care areas where new guidance is likely to have the greatest impact. These areas are set out in the NICE Forward View and are identified by the NICE prioritisation board. Patients, the public and health and social care professionals can all suggest topics for consideration. Wider areas of need identified through collaboration between NICE and NHS England are also highlighted on the NHS Innovation Service's discover opportunities for innovation page.

The NICE topic intelligence team supports the prioritisation process by providing information on system priorities, stakeholder needs and emerging technologies that could help address identified challenges. NICE uses the NHS Innovation Service as a source of information on innovations in development and searches innovation records to identify technologies relevant to its priority areas and unmet NHS needs.

Innovators can no longer submit technologies directly to NICE for evaluation. Instead, it is important to register your innovation on the NHS Innovation Service and keep your record up to date. This helps NICE maintain a clear view of available technologies, their intended use and their market readiness. NICE is currently unlikely to evaluate technologies that are not regulated by the MHRA, or are not expected to obtain the appropriate regulatory marking within the next 12 months.

NICE clinical guidelines are also produced to set out recommended care and services for people with specific conditions, diseases or needs.

The SHTG provides recommendations, assessments and innovative medical technology overviews in Scotland.

SHTG recommendations are developed by a national committee in consultation with stakeholders. The committee looks at clinical effectiveness, safety, and cost-effectiveness evidence for the technology alongside patient and public views, professional expert views, and social and organisational implications
SHTG assessments provide targeted analysis to support decision-making across health and social care in Scotland. However, assessments do not include recommendations for technologies
SHTG also produces light-touch overview of emerging evidence for innovative technologies and their potential impact on health and social care in Scotland

HTW provides guidance and reports including:

HTW topic exploration reports provide a high-level briefing on new topics for consideration by HTW and whether an area should be included in a work programme
HTW evidence appraisal reports are carried out once a topic is accepted onto the HTW work programme. HTW researchers complete a rapid review of the available evidence on the topic, assessing the available evidence
HTW guidance is produced by a HTW appraisal panel and looks at whether the evidence supports adoption of a technology in Wales, considering the evidence appraisal report alongside expert, patient and public input

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