Taking a proportionate approach to technology appraisals

We're taking a proportionate approach to our technology appraisals.

We're applying light-touch, faster evaluations to simpler low-risk treatments.

This allows us to produce rapid guidance for these topics. It also makes sure we continue to have enough time for complex areas that need tailored support.

In 2022, we introduced the first phase of a new proportionate approach to technology appraisals.

We simplified, removed, or reconfigured parts of the appraisals process. This means we applied light-touch, faster approaches to simpler, low-risk treatments allowing us to produce rapid guidance for some topics.

We’ve recommended 6 treatments in the first phase of this project, benefitting around 175,000 patients.

This process helped speed up our technology appraisals process by up to 20 weeks (45%) and increased our capacity for guidance on more complex treatments.

Treatments recommended through the proportionate approach 

How we developed the proportionate approach to technology appraisals

We carried out a series of pilots that involved new ways of working. These were developed using test-and-learn principles, exploring multiple ideas and developing them through direct experience in real technology appraisals.

We engaged with our stakeholders and industry partners throughout, to ensure we incorporated their real-time input and feedback into the project.

In July 2023, we carried out a consultation on these approaches. Following the consultation, the approaches will be incorporated into the health technology evaluation manual as part of standard process and methods.

Phase 2 of the proportionate approach

In phase 2, we are developing the following ways of working:

Pathway approach to technology appraisals

The number of new treatments for similar disease areas is increasing. At NICE, nearly half of our technology appraisals are in only 10 disease areas. This means that for some disease areas, we have to evaluate a large number of medicines in the same area.

However, there are capacity constraints across the pharmaceutical landscape which means NICE cannot just increase resources to meet the demand of the new medicines.

The pathway pilots were testing a different approach that would have allowed NICE to evaluate medicines for a disease area in a single economic model. 

Following feedback on the pilot projects for the pathways approach, NICE is currently assessing what principles and lessons from the pathways pilot it will incorporate into the Single Technology Appraisal (STA) process. More information about how this will be done will be provided in March 2024.

A report on learnings from the pilot appraisals (in renal cell carcinoma [ID6186] and non-small-cell lung cancer [ID6234]) is expected to publish in Q2 2024.

NICE want to extend their thanks to everyone who contributed to the pathway approach and look forward to sharing how the lessons learned in the pilot appraisals will be taken forwards.

High value steps

Through this approach we will identify the most important parts of the appraisals process. This will allow us to consider ways of getting to these stages sooner, whilst maintaining the rigour and robustness of our appraisals processes. 

We plan to explore these opportunities for continuous improvements to the appraisals process using simulated or retrospective pilots, while we continue to develop guidance using current methods and process. 

The high value steps approach also involves three other workstreams on ‘new ways of working’: 

Committee meeting management 

Analysis and improvements to the managing of committee time and discussions, to ensure appropriate consideration for each topic discussion.  

Process improvements 

Internal work on process efficiencies, which will impact the work of our appraisal project teams. 

Proportionate reviews 

Exploring the use of proportionate processes for topic reviews, including biosimilars and generics. 

Products with many indications

Some treatments are being licensed for many indications, such as immuno-oncology treatments.

Through this approach we will consider using alternative methods and processes for evaluating treatments we’ve looked at many times before, and for which more indications are expected.

We expect that this will speed up the process of appraisal decision making, allowing effective treatments to get to patients faster.

Rapid Entry to Managed Access 

Rapid Entry to Managed Access (REMA) is an ongoing, explorative, joint piece of work between NICE and NHS England.  

Through this work, we’re exploring how we could potentially enable earlier patient access to the most promising new technologies while ensuring value to taxpayers.  

 The project seeks to build on the UK’s world-leading experience in managed access through the Cancer Drugs Fund (CDF) and the principles which have been formally established through the launch of the Innovative Medicines Fund (IMF).  

NICE and NHS England jointly agreed on the additional principles that will govern REMA in October 2023.    

Treatments through REMA:  

  • will use existing CDF & IMF funds 
  • must have a Marketing Authorisation,   
  • require the calculation of an incremental cost-effectiveness ratio  
  • must have a full NICE assessment on exit.   

NICE is initially exploring potential technical and commercial processes for entry into REMA and plan to engage with stakeholders in the pharmaceutical industry in January 2024.