Presentation (CTI)

OBJECTIVES: Health technology assessment bodies increasingly emphasise health inequalities, yet the contribution of real-world evidence (RWE) and patient-reported outcomes (PROs) to equity-informed decision making remains unclear. Women’s health conditions - often characterised by chronic symptoms, quality-of-life (QoL) impacts, and unmet need - provide an important test case. This review examined how NICE technology appraisals (TAs) in women’s health identify and address inequalities, including the role of RWE and PROs.
METHODS: A targeted review of NICE TAs and committee discussion documents (2021-2026) was conducted across endometriosis, uterine fibroids, menopause, and gynaecological cancers. Appraisals were analysed using a structured framework for: (i) identification and nature of inequalities, (ii) use of RWE and PROs, and (iii) incorporation of equity in economic evaluation, decision-making, and implementation.
RESULTS: Consideration of inequalities was heterogeneous, predominantly descriptive and used to contextualise unmet need rather than support quantitative analysis. Non-cancer TAs focused on diagnostic delay, access barriers, and demographic variation; cancer TAs emphasised biological and eligibility-based inequalities (e.g., biomarker-defined subgroups). Across all 19 TAs, inequalities linked to ethnicity and socioeconomic status were inconsistently explored, and geographic variation in access (including postcode effects) was briefly reflected in patient testimony but not incorporated into analyses. PROs (e.g., EQ-5D) captured QoL burden and informed utilities but were rarely stratified to assess distributional impact. RWE was used variably, generally to describe burden or patient characteristics and pathways, rather than quantify or model inequalities or inform subgroup analysis. No examples of distributional cost-effectiveness analysis (DCEA) were identified, and equity-focused implementation considerations were seldom specified.
CONCLUSIONS: NICE TAs in women’s health continue to acknowledge inequalities descriptively, without formal integration into modelling, decision-making, or implementation. Although not yet fully reflected, recent NICE methodological updates (2025) on inequality evidence offer an opportunity to strengthen equity considerations through more systematic use of RWE, PROs, and attention to access and implementation.