Our recommendations are prepared by independent advisory committees comprised of both health professionals and people who are familiar with the issues that can affect patients and carers.
We make 4 types of recommendation which apply across all our medicines and health tech guidance products.
What are the types of recommendation NICE can make?
We make 4 types of recommendation that allow us to produce clear, directive, actionable guidance that is easy to understand and put into practice.
The types of recommendation we can make are:
- Can be used.
- Can be used during either:
- a managed access period (for technology appraisals and highly specialised technologies), or
- evidence generation period (for medical technologies, diagnostics, early value assessments and interventional procedures).
- More research is needed.
- Should not be used.
What do these types of recommendation look like in practice?
Can be used
A ‘can be used’ recommendation is a positive recommendation and means that there is enough evidence to show that a technology provides benefits and value for money, so it can be used routinely across the NHS.
Example
Tenecteplase can be used, within its marketing authorisation, as an option for the thrombolytic treatment of an acute ischaemic stroke in adults.
Can be used during the managed access period
Some technologies have a managed access agreement. A recommendation of this type means the technology can be used in the NHS in England during the managed access period. Managed access gives people faster access to promising new treatments.
Find out more about managed access.
Example
Etranacogene dezaparvovec can be used during the managed access period as an option for treating moderately severe or severe haemophilia B.
Can be used during evidence generation period
Some promising technologies can be implemented while evidence is generated on their clinical effectiveness and value for money.
This type of recommendation applies specifically to medical technologies, diagnostics, early value assessments and interventional procedures. It means a technology can be used while evidence is being generated in line with an evidence generation plan.
Example
Kurin Lock can only be used in the NHS alongside evidence generation, in line with NICE’s evidence generation plan.
More research is needed
This type of recommendation means that a technology has potential to provide benefits, but there is not enough evidence to support using it routinely in the NHS. It should only be used in research.
Example
More research is needed on endoscopic duodenal mucosal resurfacing for insulin resistance in type 2 diabetes.
Should not be used
The evidence suggests that this technology does not offer sufficient benefit or value for money, so it should not be used routinely in the NHS. For interventional procedures, the evidence will have shown that the procedure does not work well enough, or that there are unacceptable safety risks.
Example
Extracorporeal carbon dioxide removal (ECCO2R) should not be used for people with acute hypoxic respiratory failure.
When did NICE begin using these recommendation types?
NICE recommendations across medicines and health tech have always been aligned to be consistent, but with some necessary variation in wording. This previously resulted in 33 different recommendation options. This variation was due to differences in remit across the programmes and was mostly contained to the ‘what this means in practice’ section.
In 2024 we worked with users to streamline our recommendations into the current 4 componentised, structured recommendations. These shorter and less complex recommendations are designed to aid implementation and help our users understand them quickly.
Technology appraisal data
Find out about the decisions we make and our ways of working.