Technology appraisal recommendation categories
NICE categorises each technology appraisal (TA) as follows:
The drug or treatment is recommended for use:
- in line with the marketing authorisation from the European Medicines Agency (EMA) or Medicines and Healthcare Products Regulatory Agency (MHRA) or
- in line with how it is used in clinical practice in the NHS (or both).
An example of this type of recommendation is in technology appraisal 179. Sunitinib is recommended in line with its marketing authorisation for the treatment of unresectable or metastatic malignant gastrointestinal stromal tumours (GIST) after failure of imatinib mesilate treatment.
The recommendations have a material effect on the use of a drug or technology, and it is recommended for a smaller subset of patients than originally stated by the the marketing authorisation.
This test of materiality takes into account advice from clinical experts on the anticipated use of the technology in routine clinical practice.
In some instances, an optimised recommendation is made because the committee considers that a drug or technology is only a cost-effective treatment option for a specific group of people; for example in people who are resistant to or cannot tolerate other drugs.
An example of this type of recommendation is in technology appraisal 166, where the use of simultaneous bilateral cochlear implantation is only recommended in specific circumstances. Under this guidance, the technology is only considered to be a cost-effective use of NHS resources for:
- people with severe to profound deafness who do not receive adequate benefit from acoustic hearing aids; or
- children; or
- adults who are blind or who have other specific disabilities.
Only in research
The drug or treatment is recommended for use only in the context of a research study, for example a clinical trial. Often, particularly in the case of promising new technologies, sufficient clinical evidence has not been collected at the time of the appraisal and so the Appraisal Committee is unable to recommend the technology for use in the NHS until further evidence on its effectiveness is available for re-appraisal. The Committee will take into account whether there is a reasonable prospect of the technology being cost effective and that the research will inform future NICE guidance, whether the research can realistically be set up or is already planned or in progress, and whether the broad balance of the benefits and costs of conducting the research is favourable.
In these cases NICE will recommend further research to investigate whether the promise of the technology can be realised. In the meantime the NHS should only use the new treatment as part of a well-designed programme of research intended to answer these questions.
This type of recommendation was made for technology appraisal 17 in 2000 for laparoscopic surgery. The Appraisal Committee recommended that laparoscopic surgery for colorectal cancer can only be used as part of a randomised controlled clinical trial. The Medical Research Council carried out a clinical trial of the technology, and in 2006 when the appraisal was reviewed (technology appraisal 105), the Appraisal Committee was able to recommend the use of the intervention based on the additional evidence collected.
The treatment is not recommended. In most instances, a technology will not be recommended if there is a lack of evidence for its clinical effectiveness or if the technology is not considered to be a cost-effective use of NHS resources, compared with current NHS practice.
An example of this type of recommendation is in technology appraisal 172 where cetuximab (in combination with platinum-based chemotherapy) was not recommended for the treatment of recurrent and/or metastatic squamous cell cancer of the head and neck.
The use of cetuximab was substantially less cost-effective than what is normally considered to be an acceptable use of NHS resources. In addition there was considerable uncertainty around the clinical data used in the economic model and the committee was concerned that it would be even less cost-effective than presented.
See related information:
- summary of statistical information about TA recommendations
- frequently asked questions about TA recommendations
- full table of TA recommendations
This page was last updated: 12 August 2010