OBJECTIVES: The National Institute for Health and Care Excellence (NICE) Medical Technologies Evaluation Program (MTEP) assesses whether evidence for medical technologies supports National Health Service (NHS) adoption. However, exact evidence requirements are unspecified. This study aimed to determine evidence requirements for a positive MTEP recommendation.

METHODS: Medical Technology Guidance (MTG) published March 2017–April 2023 were reviewed. MTGs published pre-March 2017 were considered in a previous analysis.¹ Recommendations and evaluated clinical and economic evidence were assessed. To evaluate changes over time, MTGs published 2017–2022 were considered in three groups: 2017/18, 2019/20, 2021/22.

RESULTS: 42 MTGs were assessed; 13 received full support (FS, 31.0%), 14 were not supported (NS, 33.3%), 15 received partial support (PS, 35.7%). The proportion of FS MTGs fell from 4/6 (66.7%) in 2017/18 to 3/13 (23.1%) in 2019/20 and 6/22 (27.3%) in 2021/22. At least one RCT was presented in 11/13 (84.6%) FS, 9/14 (64.3%) NS and 13/15 (86.7%) PS MTGs. Of 9/42 (21.4%) MTGs presenting no RCT data, 2/9 (22.2%) received FS and PS, whilst 5/9 (55.5%) were NS. The mean number of RCTs included was 6.5 (SD: 8.7) in FS, and 1.9 in NS (SD: 2.0) and PS (SD: 1.3) MTGs. All 13 FS MTGs were deemed cost-saving/neutral, whilst 10/14 (71.4%) NS MTGs were cost-saving, in at least one setting; 3/14 (21.4%) were deemed cost-incurring, whilst cost implications of 1/14 (7.1%) were “highly uncertain.”

CONCLUSIONS: Analyses of 42 MTGs published since 2017 demonstrated that a numerically greater proportion of FS and PS MTGs present evidence from at least one RCT, compared with NS MTGs. The mean number of included RCTs was higher for FS MTGs compared with NS, suggesting the importance of robust comparative data to secure a positive recommendation. In line with MTEP requirements, all FS technologies were deemed cost-saving/neutral.