Advice
Expert comments
Expert comments
Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.
All experts were familiar with the analysis and interpretation of MRI scans in the context of multiple sclerosis (MS), 2 were familiar with the particular technology, and 1 had used icobrain ms before. Two of the experts were actively involved in research related to the technology.
Level of innovation
All experts agreed that the technology is the first in a new class of procedures. One further expanded that it is novel, but sufficiently mature to be tested for real-world implementation. All experts acknowledged that although the technology may have both patient and system benefits, it will be in addition to standard care. One expert mentioned ongoing research on implementation of the technology in the UK context and research on another, competitive technology. One expert was familiar with competitive technologies, but suggested they are at a less advanced development stage than icobrain ms.
Potential patient impact
Only 2 of the experts agreed that there would be potential benefits to patients from using the technology. The third expert felt that currently there is evidence for indirect patient benefits only, stemming from the system benefits of the technology (discussed below). It was not clear if there would be any subgroups who would particularly benefit from the technology. The experts generally did not specify using the technology in the context of relapsing–remitting MS. One expert estimated that 50,000 to 60,000 people would currently be eligible for it.
Potential system impact
A key benefit to the healthcare system would be a reduction in the use of NHS resources. All experts thought that the technology would result in reductions in staff time spent on reporting a scan, whereas 2 of them thought it could lead to increases in the sensitivity of counting lesions. Two experts expressed concerns that implementation of icobrain ms would need to be cleared with governance and PACS administration because of the icobridge software. One of them further expanded that since brain atrophy measurement is not routinely used in the NHS, using it to guide treatment choice should not be done before there are clear guidelines.
General comments
Only 1 expert suggested that there might be safety and efficacy issues, more specifically mistakes in the automatic count of lesions. In terms of impact, 1 expert thought that the technology would be used in most or all district general hospitals. One expert thought it would be used in a minority of specialist centres, and 1 could not provide an estimate. The experts agreed that further research is needed to address uncertainties in the evidence base, but 2 of them expressed a view that such research is currently being done. In terms of the needed evidence, all agreed and 1 specifically stressed that it would be particularly valuable to assess if the technology leads to better patient outcomes.