Presentation (CTI)

OBJECTIVES: Economic evaluation of non-drug health technologies presents methodological challenges due to limited comparative effectiveness, utility, and cost data. This study reviewed recent National Institute for Health and Care Excellence (NICE) HealthTech appraisals to identify evidence challenges and key drivers of favourable cost-effectiveness conclusions.
METHODS: NICE HealthTech appraisals published between May 2024 and May 2026 were screened. Appraisals that included an economic evaluation were included. Data were extracted on model structure and assumptions, evidence sources, appraisal outcomes, committee conclusions regarding cost-effectiveness, and key evidence challenges and uncertainties.
RESULTS: Sixty-one NICE HealthTech appraisals were identified. Among the 29 appraisals with an economic evaluation conducted by the Evidence Review Group (ERG), 11 (38%) included company-submitted clinical evidence, and only 6 (21%) included a company-submitted economic model. Appraisals with company-submitted models (6/6, 100%) or clinical evidence (9/11, 82%) were more likely to reach positive cost-effectiveness conclusions than those without (5/18, 28%). Cost-effectiveness could not be determined due to substantial evidence gaps in 9/18 (50%) appraisals where companies did not submit clinical or economic evidence. The NICE committee could not determine cost-effectiveness in one appraisal despite company-submitted clinical evidence. In the absence of evidence, equal effectiveness between comparators was often assumed, preventing assessment of the added value for more expensive technologies. Among the six appraisals where one or more technologies demonstrated improved outcomes versus comparators, four (67%) included company-submitted economic and clinical evidence.
CONCLUSIONS: Evidence gaps in comparative effectiveness, utilities, and resource use, remain a major challenge for the appraisal of non-drug health technologies in the UK. The findings from this review highlight the critical role of robust company-submitted clinical and economic evidence in supporting favourable NICE HealthTech decisions. Future submissions should prioritise generation of comparative clinical data, collection of quality-of-life and resource-use evidence, alongside transparent economic models, to reduce uncertainty and demonstrate the added value of technologies.