OBJECTIVES: Following an unfavourable NICE (the National Institute for Health and Care Excellence) Health Technology Appraisal (HTA) decision there are three possible grounds for appeal. These are as follows: Grounds 1a and 1b state that, in making the assessment that preceded the recommendation, NICE has failed to act fairly or exceeded its powers; and Ground 2 states that the recommendation is unreasonable in the light of the evidence submitted to NICE. The appeal panel then examine and uphold or reject each appeal point with any upheld point resulting in a re-appraisal.

METHODS: NICE HTA appeals and decisions within the last ten years were reviewed and data extracted regarding the grounds for appeal, the professional organisations submitting the appeal, which appeal points were upheld/rejected and the overall outcome of the appeal.

RESULTS: Since 2010 there have been 36 appeals considered, with a further seven rejected and three cancelled. Of the 36 considered appeals, 21 were upheld and 15 were rejected. 12 appeals were heard on grounds 1a and 2 with a further four on ground 2 alone, two on ground 1a alone and three on all grounds (1a, 1b and 2). Six appeals resulted in the technology being recommended for use in the NHS, with eight still undergoing their re-appraisal, one suspended and one with guidance withdrawn. Five re-appraisals resulted in the technologies not being recommended.

CONCLUSIONS: Appeals of HTA decisions were mostly upheld, resulting in the technologies undergoing a re-appraisal. 54% of completed re-appraisals resulted in favourable reimbursement decisions, suggesting that submitting an appeal may be a reasonable use of resources for organisations objecting to an initial decision.