Presentation (CTI)

OBJECTIVES: The National Institute for Health and Care Excellence (NICE) assesses new health technologies for the National Health Service (NHS). While these technology appraisals (TAs) aim to ensure that patients across the United Kingdom can access effective treatments, there are growing concerns that implementation may be limited by NHS resource constraints, such as service capacity, workforce shortages, and geographical variation. Previous research suggests that such constraints disproportionately affects certain patient groups and regions, potentially undermining the equitable distribution of new therapies. We aimed to examine whether recent NICE TAs explicitly consider the impact of resource constraints on equitable access to new treatments, as seen in some NICE service delivery guidelines.
METHODS: We reviewed the final appraisal determinations (FADs) of NICE TAs (excluding terminated appraisals and other types of guidance) published over the past five years (n=349). Each FAD was checked for explicit mentions of resource constraints, focusing on discussions of regional service provision, workforce capacity, and barriers to patient access.
RESULTS: Resource constraints were rarely mentioned or considered in the context of patient access. Fewer than 10% of FADs explicitly mentioned NHS capacity, workforce limitations, or regional variation as barriers to implementation. When mentioned, references were brief and lacked detail on how such constraints might impact equitable access or exacerbate health inequalities. Most appraisals focused on clinical and cost-effectiveness without systematically addressing real-world delivery challenges.
CONCLUSIONS: Capacity constraints and other resource limitations are rarely acknowledged in NICE TAs, despite their potential impact on the real-world feasibility of launching new treatments. To better align guidance with NHS realities and support health equity, future appraisals should consider service capacity, workforce availability, and regional variation. Broader adoption of this approach would help ensure that all patients can benefit from recommended therapies and could further NICE’s objectives in promoting equitable access to recommended therapies.