Presentation (CTI)

OBJECTIVES: Health Technology Assessment (HTA) is increasingly being recognised as a tool to address health inequalities by evaluating the impact of new technologies on different population groups. To what extent do pivotal trials or real-world evidence (RWE) include racially diverse populations, and do appraisal committees explicitly consider the health inequality impacts of guidance on racially diverse populations? Using NICE HTAs assessing technologies for chronic kidney disease (CKD), hypertension and diabetes, diseases common in racial and ethnic minorities, this study sought to answer these questions.
METHODS: Document analysis of publicly available NICE HTA reports for CKD, hypertension, diabetes and related complications, published between 2010 and May 2025 was conducted. Data were extracted on racial composition of pivotal trial participants, use of RWE, subgroup analyses by race, and whether race was raised as an equality issue by appraisal committees.
RESULTS: A total of 16 HTA reports covering technologies for CKD (n=3), hypertension (n=1), diabetes (n=8), anaemia (n=2), and hyperkalaemia (n=2) were identified, including 47 pivotal clinical trials. HTA reports described the race of trial participants in 48.9% of trials. Overall (N=34,005 participants), 65.3% of the trial participants were white compared with 22.4% Asian, 7.1% Black or African American, and 5.2% mixed or other races. Racial subgroup analyses were described in the HTA report for only 13 (27.7%) of the trials. Only 3 HTA reports included RWE studies, and 2 reports described the race of participants. Equality issues related to race were explicitly discussed or raised in 9 HTAs.
CONCLUSIONS: We highlight gaps in representation of racial minorities in clinical trials used in HTAs for CKD, hypertension and diabetes. Strengthening incorporation and reporting of diverse populations, and integrating RWE are critical steps for equitable health technology evaluation. Whilst acknowledging differential disease prevalence, most appraisal committees did not consider these equality considerations relevant to the appraisals.