Health Technology Assessment

Health Technology Assessments (HTA) involve a multidisciplinary process that systematically review the evidence around the safety, clinical effectiveness, efficacy, and cost effectiveness of a technology, as well as any social, legal and ethical considerations that may arise as a result of its use. In this context, ‘technologies’ are not limited to just new drugs, but can mean any method that can be used to promote health through the diagnosis, prevention, treatment, or management of disease.

The main purpose of a HTA is to determine the clinical and cost effectiveness of a technology for health care providers (such as the NHS) in comparison to other alternatives. It does this by looking at whether the technology works, for whom, at what cost, and how these factors compare to other alternatives.

In England and Wales, The National Institute for Health and Care Excellence (NICE) produces guidance on the use of new technologies for use in the NHS, as well as guidelines for clinical practice which focus on specific diseases or medical conditions.

NICE depends on the National Institute for Health Research Health Technology Assessment Programme (NIHR HTA) to provide independent, high-quality reviews of evidence on which to base its guidance. This usually takes the form of a Technology Assessment Review, commissioned by NIHR HTA and conducted by one of nine Evidence Review Groups, such as ours.

Technology Assessment Reviews can take the form of either multiple technology assessment or single technology assessment reports. It takes 24 weeks to produce a multiple technology assessment report, and 8 weeks for a single technology assessment report, although the process from start to finish is much longer.

Read more about these processes

Although the Technology Assessment reports are sent to NICE, it is the Appraisal Committee’s role to determine if, and how, health technologies are to be implemented by the NHS. The appraisal process is not purely scientific; it also includes considerations of policy, ethics and implementation and is conducted separately from the assessment process.

Health Technology Assessment projects at LRiG

Selpercatinib for previously treated RET fusion-positive advanced non-small-cell lung cancer (TA760)

Selpercatinib (Retsevmo) is available through the Cancer Drugs Fund. The focus of this appraisal is on the use of selpercatinib as a treatment for adults with advanced (Stage IIIB to Stage IV), rearranged during transfection fusion-positive non-small cell lung cancer (RET+ NSCLC) who need systemic therapy after immunotherapy, platinum-based chemotherapy or both. Following this appraisal, NICE will decide whether or not to recommend it for use on the NHS and update the guidance. It will be available through the Cancer Drugs Fund until then.

Upadacitinib for treating active psoriatic arthritis after inadequate response to DMARDs (ID2690)

Upadacitinib (Rinvoq, AbbVie) is a Janus-kinase (JAK) 1 inhibitor that blocks the JAK-signal transducer and activator of transcription (STAT) pathway and inflammatory responses. Upadacitinib does not currently have a marketing authorisation in the UK for treating psoriatic arthritis. It has been studied in clinical trials compared with placebo and adalimumab in adults with active psoriatic arthritis whose disease has not responded adequately to at least 1 DMARD. The focus of this appraisal is on the use of upadacitinib (RINVOQTM) to treat active psoriatic arthritis (PsA) after inadequate response to disease modifying anti-rheumatic drugs (DMARDs).  Following this appraisal, NICE will decide whether or not to recommend it for use on the NHS and update the guidance.

Nivolumab in combination with chemotherapy for untreated advanced gastric or gastro-oesophageal junction cancer (ID1465)

Nivolumab (Opdivo, Bristol-Myers Squibb) is a humanised monoclonal antibody that targets and blocks a receptor on the surface of lymphocytes known as PD-1. This receptor is part of the immune checkpoint pathway, and blocking its activity may promote an anti-tumour immune response. It does not have a marketing authorisation in the UK for locally advanced or metastatic gastric or gastro-oesophageal junction cancer. It is being studied in a clinical trial which randomised patients into three treatment arms; nivolumab in combination with chemotherapy, nivolumab in combination with ipilimumab and chemotherapy only. The focus of this appraisal is on the clinical and cost effectiveness of nivolumab in combination with chemotherapy within its marketing authorisation for untreated advanced gastric or gastro-oesophageal junction cancer. Following this appraisal, NICE will decide whether or not to recommend it for use on the NHS and update the guidance.

For more examples see the Projects page.

Recent Health Technology Assessment publications

Brentuximab Vedotin for Treating Relapsed or Refractory CD30-Positive Cutaneous T-Cell Lymphoma: An Evidence Review Group Perspective of a NICE Single Technology Appraisal

As part of the single technology appraisal process, the National Institute for Health and Care Excellence commissioned LRiG to act as the evidence review group (ERG) to review clinical- and cost-effectiveness evidence for brentuximab vedotin (BV) for treating relapsed or refractory CD30-positive (CD30+) cutaneous T-cell lymphoma (CTCL). This article summarises the ERG's review of the company's submission for BV and the appraisal committee decision.

PharmacoEconomics Open. 2020; 4, 563–574. Nigel Fleeman. Rachel Houten. Marty Chaplin. Angela Boland. Yenal Dundar.

Encorafenib with Binimetinib for the Treatment of Patients with BRAF V600 Mutation-Positive Unresectable or Metastatic Melanoma: An Evidence Review Group Perspective of a NICE Single Technology Appraisal

As part of the single technology appraisal process, the National Institute for Health and Care Excellence commissioned LRiG to act as the evidence review group (ERG) to review clinical- and cost-effectiveness evidence for encorafenib with binimetinib (Enco + Bini) versus dabrafenib with trametinib (Dab + Tram) as a first-line treatment for advanced (unresectable or metastatic) BRAF V600 mutation-positive melanoma. This article summarises the ERG's review of the company's submission for BV and the appraisal committee decision.

PharmacoEconomics Open. 2021; 5, 13–22. Rachel Houten. Janette Greenhalgh. Sarah Nevitt. Angela Boland. Tosin Lambe. Yenal Dundar.

Lenvatinib and sorafenib for differentiated thyroid cancer after radioactive iodine: a systematic review and economic evaluation

The research reported in this issue of the Health Technology Assessment journal was commissioned and funded by the HTA programme on behalf of NICE as project number 16/51/20. Differentiated thyroid cancer is a common type of thyroid cancer. For many patients, radioactive iodine is an effective treatment; however, for some patients, the treatment stops working or becomes unsafe. Two new drugs, lenvatinib (Lenvima®; Eisai Ltd, Hertfordshire, UK) and sorafenib (Nexar®; Bayer HealthCare, Leverkusen, Germany), may be new treatment options. We reviewed the clinical evidence of lenvatinib and sorafenib and estimated the costs and benefits of treatment.

Health Technology Assessment. 2020; 24 (2). Nigel Fleeman. Rachel Houten. Marty Chaplin. Angela Boland. Yenal Dundar. Janette Greenhalgh. Juliet Hounsome. Rui Duarte.  

For more examples see the Publications page.


Health Technology Appraisal reports

Below is a list of reports that that we have produced since 2015 as part of the NIHR Technology Assessment Review (TAR) Programme:

Atezolizumab for untreated, locally advanced or metastatic, triple negative breast cancer (TA639) Link

Pembrolizumab for untreated metastatic or unresectable recurrent head and neck squamous cell carcinoma (TA661) Link

Palbociclib in combination with fulvestrant for treating advanced oestrogen-receptor positive, HER2-negative breast cancer (TA619) Link

Osimertinib for untreated epidermal growth factor receptor (EGFR) mutation-positive non-small-cell lung cancer (TA654) Link

Brentuximab vedotin for treating relapsed or refractory CD30-positive cutaneous T-cell lymphoma (TA557) Link

Encorafenib in combination with binimetinib for treating advanced (unresectable or metastatic) BRAF V600 mutation-positive melanoma (TA562) Link

Pembrolizumab for adjuvant treatment of resected melanoma with high risk of recurrence (TA553) Link

Nivolumab in combination with ipilimumab for untreated advanced or metastatic renal cell carcinoma (TA581) Link

Crizotinib for treating ROS1-positive advanced non-small-cell lung cancer (TA529) Link

Pembrolizumab for untreated PD-L1-positive metastatic non-small cell lung cancer (TA447) Link

Eribulin for treating locally advanced or metastatic breast cancer after 2 or more chemotherapy regimens (TA423) Link

Cladribine tablets for the treatment of relapsing-remitting multiple sclerosis (TA616) Link

Paclitaxel as albumin-bound nanoparticles with gemcitabine for untreated metastatic pancreatic cancer (TA476) Link

Atezolizumab for treating locally advanced or metastatic non-small-cell lung cancer after platinum-based chemotherapy (TA520) Link

Cenegermin for treating neurotrophic keratitis (TA532) Link

Pembrolizumab for untreated PD-L1-positive metastatic non-small-cell lung cancer (TA447) Link

Lenvatinib and sorafenib for treating differentiated thyroid cancer after radioactive iodine (TA535) Link

Palbociclib with an aromatase inhibitor for previously untreated, hormone receptor-positive, HER2-negative, locally advanced or metastatic breast cancer (TA495) Link

Holoclar for treating limbal stem cell deficiency after eye burns (TA467) Link

Eribulin for treating locally advanced or metastatic breast cancer after 2 or more chemotherapy regimens (TA423) Link

Pegylated liposomal irinotecan for treating pancreatic cancer after gemcitabine (TA440) Link

Osimertinib for locally advanced or metastatic EGFR and T790M mutation-positive non-small cell lung cancer (TA416) Link

Trametinib in combination with dabrafenib for treating advanced (unresectable or metastatic) BRAF V600 mutation-positive melanoma (TA396) Link

Talimogene laherparepvec for treating metastatic melanoma (GID-TAG509) Link

Nivolumab for previously treated locally advanced or metastatic squamous non‑small cell lung cancer (TA483) Link

Pembrolizumab for treating unresectable, metastatic melanoma after progression with ipilimumab (TA357) Link

Pembrolizumab for treating advanced melanoma in people previously untreated with ipilimumab (TA366) Link

Edoxaban tosylate for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation (TA355) Link

Ciclosporin for treating dry eye disease (TA369) Link

 

If you wish to see a list of our reports prior to 2015 please conact us