Routing Decisions and Outcomes of NICE Technology Appraisals Underproportionate Approach to Technology Appraisals

OBJECTIVES: On 24 April 2023, NICE formally introduced its proportionate approach to technology appraisals (PATT), which included the introduction of the Cost Comparison Appraisal (CCA) route and streamlined Single Technology Appraisal (STA) process to enable rapid guidance production for appropriate topics. We aimed to understand how frequently different routes/processes were used and their corresponding outcomes.
METHODS: We screened all NICE Technology Appraisals (TAs) published between 1 October 2023 and 30 April 2025 to identify and characterize different TA routes and outcomes since routine PATT introduction.
RESULTS: Of 139 TAs screened, 27 were terminated/withdrawn and 65 had an Invitation to Participate (ITP) date after 24 April 2023: 15 CCAs, 46 standard STAs, and four streamlined STAs. Within each route, 33%, 57% and 75% were appraisals for oncology products, respectively. Median (min, max) time from ITP to guidance publication was 30 (23, 50) for CCAs, 49 (36, 59) for streamlined STAs and 52 (34, 94) for standard STAs. As per NICE process, all CCAs and streamlined STAs had a positive recommendation outside of a formal committee meeting. Of the 46 standard STAs, 18 had decision within one committee meeting, 24 within two, and four within three or more committee meetings; 21 received full recommendations, 20 optimized recommendations, three recommendations within Managed Access, and two negative recommendations.
CONCLUSIONS: Since PATT introduction, a considerable proportion (23%) of TAs were CCAs, mostly for non-oncology indications (67%). As intended, CCAs had shorter time to guidance publication compared with STAs, while streamlined STAs had shorter time to guidance publication than standard STAs. Almost all technologies appraised by NICE during our research period had a positive recommendation, although a high number of terminations (almost 1 in 5 TAs published during the research period) could suggest appraisals at risk of negative recommendation are terminated early.