Next steps
14. NICE's first disease-specific reference case extension will be released for consultation in 2026 for the treatment of obesity and weight-related comorbidities. The development process will include a literature review of cost–utility analyses and expert input from:
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clinical experts and patient representatives
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health economist analysts and modellers
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industry stakeholders
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commissioners of NHS services.
15. The conceptual model developed by NICE's HTA Lab for metabolic dysfunction-associated steatohepatitis (MASH) will be adapted into a disease-specific reference case extension in 2026 to 2027.
16. A governance process, with stakeholder input, will be developed to support the transparent and proportionate selection of topics for the development of a reference case extension.
17. To promote adherence to a disease-specific reference case extension, the scoping process of technology appraisals (TAs) and guidelines will be adapted to signpost to reference case extensions in the scoping document. In TAs and health technology evaluations, company submissions and EAG report templates will be adapted to include a description of how the company's analysis adhered to the disease-specific reference case extension. All products will capture committee assessment of how well the reference case extension has been implemented.
18. A NICE process will be developed for maintaining reference case extensions as the evidence base grows. The process will also include retiring reference case extensions if it is decided that the benefits of maintaining them are not justified.
19. NICE will consider resourcing and technologies for ongoing maintenance and updating of reference models and reference case extensions. It will also consider how other programmes at NICE, such as the HTA Lab, can support more dynamic updating of existing models (see NICE's information on the future of HTA with AI).
20. NICE will assess and learn from using disease-specific reference case extensions in NICE evaluations. It will consider whether the opportunities outweigh the challenges to NICE's guidance development processes. This position statement will be reviewed following implementation of the MASH and obesity reference case extensions.
21. An update to NICE's methods manuals concerning the use of disease-specific reference case extensions will be considered where appropriate.
22. NICE will continue to explore and build on collaborative opportunities with other HTA agencies (for example, see information on NICE's international collaborations).
If you have any questions or comments about this position statement, please contact us at the following email address: ReferenceModels@nice.org.uk.