NICE-wide topic prioritisation: the manual
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8 Prioritisation framework
8.1 Developing topic briefings for prioritisation
If a new topic or an update is eligible for assessment using the prioritisation framework (see section 6), a topic briefing is developed to support decision making.
NICE will keep its sponsor teams at the Department of Health and Social Care (DHSC) and NHS England (NHSE) updated on all proposed new topics and updates that will be assessed by the prioritisation board.
The topic briefing will provide information on the new topic or update, and how the prioritisation framework criteria are met or not met. The topic briefing summarises:
the title of the new topic or update
the context (including description of the use case for HealthTech, if applicable)
related NICE guidance
the potential impact on related NICE guidance.
When appropriate, input will be sought from a relevant regulator, committee, or other organisations (such as NHSE, Greener NHS, DHSC, Office for Health Improvement and Disparities, Health Innovation Networks, Office for Life Sciences and NHS Supply Chain), and relevant topic experts (such as patients, clinical and academic experts).
The NICE strategic principles to public health, social care and rare diseases will be applied alongside the prioritisation framework, where appropriate, particularly when considering health and care need, population impact, and health inequalities.
8.2 Prioritisation framework criteria
The prioritisation framework criteria are used to determine if a new topic or a proposed update of existing guidance is appropriate for NICE to address. Information in the topic briefing will be used to assess each criterion qualitatively.
The NICE prioritisation board will make an overall final decision whether the new topic or proposed update of existing guidance should be prioritised, with clear rationales on the trade-off among the 6 criteria specific to the topic of interest.
8.2.1 The 6 prioritisation framework criteria
Budget impact
The likely impact on health and care system budgets of implementing the new or updated guidance. This may be:
a disinvestment opportunity
cost saving or cost neutral
more expensive or cost incurring to the system.
A topic area that is more expensive or cost incurring to the system does not necessarily mean it will be disadvantaged during consideration. The decision from the NICE prioritisation board is based on a deliberation of the trade-offs across all criteria.
System impact
The potential impact of the new or updated guidance on health and care infrastructure, clinical pathways and services, capacity and capability for implementation, including availability of the interventions or services and current access. For example, the guidance may:
address current system infrastructure or clinical pathways and services constraints, including availability and access, or workforce capacity constraints or burden
have no or negligible impact on current system infrastructure or clinical pathways and services, including availability and access, or workforce capacity (for example, it could be incorporated into the existing care pathway)
be challenging to achieve because of infrastructure or clinical pathways and services constraints, including availability and access, or workforce capacity constraints in the relevant public-funded services
support the health and care system in its shift to focus on secondary prevention.
Population impact
The potential impact of the new or updated guidance on the target population, for example:
the size of the target population
the anticipated potential for guidance to improve patient or service user outcomes by reducing avoidable illness, harm or care burden, morbidity and premature mortality, increasing quality of life, and addressing gaps or variations in current practice.
Consideration of population impact will not merely focus on the prevalence of the condition but will also consider whether the target population is experiencing severely life-limiting or debilitating diseases (for example, rare diseases) with a lack of, or no, treatment options.
Evidence quality and system intelligence
Availability of:
evidence that meets NICE's quality requirements and addresses relevant clinical and service outcomes
accurate system intelligence that indicates gaps or variations in current practice, or where there is a need for NICE to inform best practice.
The assessment of the volume and quality of available evidence will be contextual to the potential topic area, acknowledging that some topic areas are not suitable or ethical to be addressed by randomised controlled trials, for example, topic areas in rare diseases, children and young people, and the effectiveness of invasive surgical procedures. The assessment will also need to be contextual to the purpose of the potential topic area, for example, for disinvestment opportunities, the lack of evidence to justify cost variations for an intervention is equally important.
Health inequalities
The potential for the new or updated guidance to:
introduce, increase or reduce health inequalities
have no health inequalities impact
address one of the Core20Plus5 focus areas.
Because different health inequalities may be simultaneously impacted to different degrees and in opposing ways in different sub-populations, a breakdown of the criterion to sub-criteria to indicate opposing impact may be appropriate during the assessment. For example, an online intervention may improve access for disadvantaged groups who have difficulties in physically attending a hospital or clinic, but the online intervention may disadvantage other populations who may not be digitally literate.
When there is appropriate evidence or intelligence, the impact of the wider determinants of health (such as social, economic and environmental factors) on health outcomes will also be considered during the deliberations of the NICE prioritisation board.
Environmental sustainability
The potential for the new or updated guidance to reduce avoidable production and consumption of healthcare through:
the prevention of ill health and the future need for services, and
appropriate disinvestment, and/or
the existence of a link between the guidance and a medicine or product prioritised for substitution or disinvestment in the Delivering a Net Zero NHS report or subsequent NHS or other national guidance related to environmental duties in the Health and Care Act 2022.
8.2.2 Assessment, deliberation and decision making
Each prioritisation framework criterion will be assessed as having a:
positive impact or
negative impact or
nil or neutral impact or
unknown or unclear impact.
A fixed scoring and weighting approach will not be applied to the criteria because individual criterion will have different levels of impact based on the topic area of interest. For example, there should not be a fixed numerical score or weighting for population impact as a criterion when assessing the priority of high prevalence but self-limiting upper respiratory tract infections, in comparison to low prevalence but debilitating conditions such as motor neurone disease.
The decision-making approach is a combination of the framework and the NICE prioritisation board members' deliberations and discussions about the trade-offs between the different criteria specific to the topic area of interest.
After the deliberations, the NICE prioritisation board members will do a formal voting process on either 'yes, it is a priority' or 'no, it is not a priority'. If there is a tie between a 'yes' and a 'no', the chair of the NICE Prioritisation Board will cast the final decisive vote. The rationales for the trade-offs and the deliberations by the NICE prioritisation board will be documented transparently and published on the NICE website.
For positive final decisions, the NICE prioritisation board will further discuss routing considerations, based on all the information available including all related NICE guidance. The NICE prioritisation board could make routing decisions that involve the development or update of single guidance or combination of related guidance products, to incorporate or retire other related guidance during the development or update of the topic area.
The National Institute for Health and Care Excellence (Constitution and Functions) and the Health and Social Care Information Centre (Functions) Regulations 2013 require a direction from the Secretary of State formally referring the topic before NICE is able to make a technology appraisal (for example, a medicine, health or medical technology) or highly specialised technologies recommendation on a technology.
NICE requests a ministerial referral once a new topic has been selected. The ministerial referral does not specify where the topic is routed to because routing is NICE's responsibility. For information on highly specialised technologies and the routing criteria, see highly specialised technologies: NICE prioritisation board routing criteria. For proposals to the Secretary of State for HealthTech using NICE's technology appraisal process please see Annex A. For all other guidance, NICE develops this in accordance with the relevant legislation.
8.2.3 Possible outcomes for a topic that has not been prioritised
For a topic that has not been prioritised, the prioritisation board members will discuss possible outcomes that are more appropriate for addressing the topic or update. These may include:
revisiting the topic or update later, for example, when more evidence or system intelligence becomes available
producing an alternative product such as a quality standard or clinical knowledge summary
developing research recommendations with engagement from potential research funders, such as the NIHR, UK Research and Innovation (UKRI), and the Association of Medical Research Charities (AMRC)
cross-referencing to suitable guidance or guideline recommendations produced by other organisations
engaging with external bodies to explore appropriate solutions (for example, the royal colleges, specialist societies, other arms-length bodies or other guidance-producing organisations)
no further action
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