We know that people are interested in the number of drugs and treatments we recommend so we publish details of our technology appraisal decisions regularly.

Our technology appraisals assess the clinical and cost-effectiveness of health technologies, such as new pharmaceutical and biopharmaceutical products, to ensure that all NHS patients have access to the most clinically- and cost-effective treatments available.

Each appraisal can have 1 or more recommendation, and can contain more than 1 type of recommendation. This means that there are more recommendations than there are appraisals in the tables below.

Recommended

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).

When we recommend a treatment 'as an option', the NHS must make sure it is available within 3 months (unless otherwise specified) of its date of publication. This means that if a patient has a disease or condition, and the doctor responsible for their care thinks that the technology is the right treatment, it should be available for use in line with our recommendations.

 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.

 Optimised

The technology is recommended for a smaller subset of patients than originally stated by the marketing authorisation.

Sometimes the committee decides that a drug is only cost-effective as a treatment option for a specific group of people, for example, those who are resistant to or can't tolerate other drugs.

An example of this type of recommendation is in technology appraisal 166 . 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.

This sometimes happens for new technologies when there isn't yet enough clinical evidence to make a recommendation for use in the NHS. In these cases we recommend that further research is carried out.

When making this type of recommendation, the committee takes into account whether:

  • there is a reasonable prospect of the technology being cost-effective
  • the research will inform future NICE guidance
  • the research can realistically be set up, is already planned or is in progress
  • the benefits and costs of conducting the research are favourable.

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.

Not recommended

The treatment is not recommended.

This happens when there is a lack of evidence for the clinical effectiveness of the technology, or if it's 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.

Recommended for use in the CDF (for cancer appraisals only)

It there is early evidence that a drug has clinical benefits for cancer patients, but still needs more evidence to prove its cost effectiveness, then we can recommend it for use within the Cancer Drugs Fund. This means that new cancer drugs can be made available to patients much more quickly than before.

Find out more about the Cancer Drugs Fund

Technology appraisal decisions

From 1 March 2000 to 30 September 2017 we published:

  • 297 single technology appraisals (STA)
  • 179 multiple technology appraisals (MTA)
  • 476 appraisals in total
  • 759 individual recommendations in total.

Overall, 82% of decisions made by NICE (587 of 714) were recommended, optimised or recommended for use in the CDF.

1 March 2000 to 30 September 2017

Recommendation categories

Single Technology Appraisal

Multiple Technology Appraisal

Total

Recommended

153 (53%)

264 (62%)

417 (58%)

Optimised

74 (25%)

91 (21%)

165 (23%)

CDF

5 (2%)

-

5

Only in Research

5 (2%)

22 (5%)

27 (4%)

Not Recommended

52 (18%)

48 (12%)

100 (15%)

Total

289 (100%)

425 (100%)

714 (100%)

Not included in the table

7 recommendations were subsequently withdrawn where:

  • the regulator revoked the marketing authorisation due to safety concerns (3)
  • the product was no longer produced by the company (2)
  • a nationally funded-programme for a technology rendered the guidance obsolete (2).

38 recommendations could not be made in the absence of a submission from the company (known as a non-submission). These are not included in the table.

All our recommendations

We also produce a full list of all our published technology appraisal guidance recommendations. 

  Full list of recommendations  (Word document)  1.2MB

For each recommendation, the document  shows:

  • the appraisal number
  • year of publication
  • appraisal process
  • the name of the technology
  • the disease or condition for which the technology has been appraised
  • how NICE has categorised this recommendation
  • any comments.

An individual appraisal may contain more than one recommendation. In some appraisals, many technologies have been considered together, and a number of recommendations made. Each recommendation is summarised separately.

NICE and cancer drugs - the facts

How many recommendations has NICE made?

Since 2000, when NICE started to produce cancer guidance, NICE has published 255 individual recommendations on cancer drugs in 196 technology appraisals.

Overall, 69% of our recommendations for cancer drugs state that the NHS should use these drugs in line with their marketing authorisation (recommended), in specific circumstances (optimised recommendation) or for use in the CDF.

Breakdown of decisions in published technology appraisals for anti-cancer agents.
Recommendations for cancer appraisals 1 March 2000 to 30 September 2017 1 January to 30 September 2017
STA MTA Total
Yes 68 (51%) 63 (64%) 131 (57%) 12 (53%)
Optimised 21 (16%) 3 (3%) 24 (10%) 6 (26%)
CDF 5 (4%) - 5 (2%) 4 (17%)
Only in research 2 (1%) 6 (6%) 8 (3%) -
No 36 (28%) 27 (27%) 63 (28%) 1 (4%)
Total 132 (100%) 99 (100%) 231 (100%) 23 (100%)
STA = single technology appraisal, MTA = multiple technology appraisal

Not included in the table

24 non-submission recommendations have been excluded.

End of life

Drugs, especially those for cancer, which extend life at the end of life are very important and since January 2009, NICE has given special weight to them.

In 2009, we agreed new criteria for appraising drugs which can extend life for people with terminal cancer. Up to 30 September 2017, 99 pieces of guidance have been published where these new criteria were considered, of which 52 resulted in positive recommendations for use in the NHS.

End of life drugs recommended by NICEGuidance number
Lenalidomide for multiple myeloma TA171
Sunitinib for the first-line treatment of renal cell carcinoma and for unresectable and/or metastatic GIST TA169/TA179
Oral topotecan for small-cell lung cancer TA184
Trabectedin for soft tissue sarcoma TA185
Pemetrexed maintenance treatment for non-small cell lung cancer TA190
Trastuzumab plus cisplatin and capecitabine or 5-fluorouracil for HER2-positive metastatic gastric cancer (IHC3 positive subgroup only) TA208
Pazopanib for renal cell carcinoma TA215
Azacitadine for myelodysplastic syndromes TA218
Abiraterone in combination with prednisolone for the castration-resistant metastatic prostate cancer TA259
Ipilimumab for advanced melanoma in adults who have received prior therapy and vemurafenib for BRAF V600 mutation-positive unresectable or metastatic melanoma TA268
Vemurafenib for treating locally advanced or metastatic BRAF V600 mutation‑positive malignant melanoma TA269
Enzalutamide for metastatic hormone relapsed prostate cancer previously treated with a docetaxel containing regimen TA316
Ipilimumab for previously untreated advanced melanoma TA319
Axitinib for treating advanced renal cell carcinoma after failure of prior systemic treatment TA333
Nintedanib for previously treated locally advanced, metastatic, or locally recurrent non‑small‑cell lung cancer TA347
Pembrolizumab for treating advanced melanoma after disease progression with ipilimumab TA357
Idelalisib for treating chronic lymphocytic leukaemia TA359
Pembrolizumab for advanced melanoma not previously treated with ipilimumab TA366
Olaparib for maintenance treatment of relapsed, platinum-sensitive, BRCA mutation-positive ovarian, fallopian tube and peritoneal cancer after response to 3 or more courses of platinum-based chemotherapy TA381
Nivolumab for treating advanced melanoma TA384
Ruxolitinib for treating disease-related splenomegaly or symptoms in adults with myelofibrosis TA386
Cabazitaxel for hormone-relapsed metastatic prostate cancer treated with docetaxel TA391
Ceritinib for previously treated anaplastic lymphoma kinase positive non-small-cell lung cancer TA395
Trametinib in combination with dabrafenib for treating unresectable or metastatic melanoma TA396
Bosutinib for previously treated chronic myeloid leukaemia TA401
Pemetrexed maintenance treatment for non-squamous non-small-cell lung cancer after pemetrexed and cisplatin TA402
Ramucirumab for previously treated locally advanced or metastatic non-small-cell lung cancer TA403
Trifluridine–tipiracil for previously treated metastatic colorectal cancer TA405
Crizotinib for untreated anaplastic lymphoma kinase-positive advanced non-small-cell lung cancer TA406
Radium-223 dichloride for treating hormone-relapsed prostate cancer with bone metastases TA412
Nivolumab for previously treated advanced renal cell carcinoma. TA417
Crizotinib for previously treated anaplastic lymphoma kinase-positive advanced non-small-cell lung cancer TA422
Eribulin for treating locally advanced or metastatic breast cancer after 2 or more chemotherapy regimens TA423
Dasatinib, nilotinib and high-dose imatinib for treating imatinib-resistant or intolerant chronic myeloid leukaemia TA425
Pomalidomide for multiple myeloma previously treated with lenalidomide and bortezomib TA427
Pembrolizumab for treating PD-L1-positive non-small-cell lung cancer after chemotherapy TA428
Ibrutinib for previously treated chronic lymphocytic leukaemia and untreated chronic lymphocytic leukaemia with 17p deletion or TP53 mutation TA429
Cetuximab and panitumumab for previously untreated metastatic colorectal cancer TA439
Pembrolizumab for untreated PD-L1-positive metastatic non-small-cell lung cancer TA447
Everolimus and sunitinib for treating unresectable or metastatic neuroendocrine tumours in people with progressive disease TA449
Blinatumomab for previously treated Philadelphia-chromosome-negative acute lymphoblastic leukaemia TA450
Ponatinib for treating chronic myeloid leukaemia and acute lymphoblastic leukaemia TA451
Trastuzumab emtansine for treating HER2-positive advanced breast cancer after trastuzumab and a taxane TA458
Nivolumab for treating relapsed or refractory classical Hodgkin lymphoma TA462
Cabozantinib for previously treated advanced renal cell carcinoma TA463
Olaratumab in combination with doxorubicin for treating advanced soft tissue sarcoma TA465
Cetuximab for treating recurrent or metastatic squamous cell cancer of the head and neck TA473
Sorafenib for treating advanced hepatocellular carcinoma TA474
Paclitaxel as albumin-bound nanoparticles with gemcitabine for untreated metastatic pancreatic cancer TA476

Frequently asked questions about the technology appraisal statistics

A single technology appraisal (STA) looks at a single technology for a single indication close to the introduction of a new technology to the NHS.

A multiple technology appraisal (MTA) will normally cover more than one technology (for example a class of drug), or one technology for more than one indication (for example, a drug for more than one place in a treatment sequence for a particular condition). The multiple technology appraisal process is also often used for reviews of published appraisals, regardless of the number of technologies involved, or if a new topic for an appraisal is particularly complex and not suited for the single technology appraisal process.

A marketing authorisation is the term used to describe the licence given to new medicines allowing the manufacturer to sell and promote the product. All drugs must be licensed before they can be used by patients.

In Europe the European Medicines Agency (EMA) carries out this role, and many assessments in the UK are undertaken by the Medicines and Healthcare Products Regulatory Agency (MHRA). In the US this is done by the US Food and Drug Administration (FDA).

The regulatory agency carries out an assessment to establish if the new medicine does what it is claimed to do. For example, does it lower blood pressure, shrink a tumour or prevent bone fracture? The regulator also makes a judgment on the balance of benefit to harm.

The resulting marketing authorisation allows the manufacturer to sell and promote the new medicine for the indication(s) that the regulatory agencies have assessed and approved.

Commercial databases are available which categorise NICE technology appraisal decisions using different criteria from NICE. As these criteria have been developed independently from NICE, their categories may be different from ours.

The data in the full table of recommendations and the summary table was issued in July 2010 and is updated regularly.

Each recommendation takes account of advice the Appraisal Committee receives (and incorporates into the guidance) from clinical experts. Sometimes experts suggest that the technology is unlikely to be used routinely in clinical practice in the UK, to the extent permitted by the licence. In these cases, the recommendation may be classed as ‘recommended' because this is in line with clinical practice.

All licensed drugs are ‘effective' in so far as the licensing process requires manufacturers to provide evidence to support claims that their drug works in specific populations and specific circumstances. Obtaining a licence doesn't necessarily require any evidence about how the drug compares to other similar treatments in the NHS or how well it works in all people with a particular condition. NICE, on the other hand, compares the drug with what is currently used in the NHS and works out how well the drug would work in real life use.

A single technology appraisal is based on a submission from the manufacturer of the technology. If there is no submission from the manufacturer, the appraisal is terminated and advice is issued to the NHS that NICE is unable to make a recommendation because the manufacturer has not provided a submission. To date this has occurred 18 times.

When NICE recommends a treatment 'as an option', the NHS must make sure it is available within 3 months (unless otherwise specified) of its date of publication. This means that, if a patient has a disease or condition and the doctor responsible for their care thinks that the technology is the right treatment, it should be available for use, in line with NICE's recommendations.

The technology being appraised is listed in the scope of an appraisal under 'intervention'. NICE can only issue guidance/make recommendations about the intervention being appraised. A comparator technology is one that is currently used in the NHS and could be replaced by the intervention, if recommended. NICE cannot issue guidance or make recommendations about comparator technologies (unless also listed as an intervention in a multiple technology appraisal).