The NICE Topic Selection Oversight Panel (TSOP), with membership from NICE, Department of Health and Social Care (DHSC) and NHS England, met in June 2022 to carefully consider the suitability of this topic for Highly Specialised Technologies (HST) evaluation. Topics will be considered eligible for routing to highly specialised technologies guidance if they fulfil the selection considerations and meet all 4 of the routing criteria. Please see section 7.2 of the topic selection manual for further details. The panel concluded that although the topic meets some of the criteria for a HST, it does not meet all criteria. Therefore, decision makers agreed that the HST programme would not be suitable to evaluate this technology. The TSOP decision was for pegunigalsidase alfa for treating Fabry disease to remain as a Technology Appraisal (TA). The conclusion of the panel, with ratification from the NICE Executive Team, to evaluate pegunigalsidase alfa for treating Fabry disease as a Technology Appraisal (TA) is now regarded as final.