OBJECTIVES: Early-stage medical technology assessment (MTA) is sometimes conducted in an ad-hoc manner, if it is performed at all. Identification of universal steps in early-stage MTA would catalyze the development of valuable technology. METHODS: Universal steps in early-stage MTA were developed following evaluation of a new stroke rehabilitation strategy targeting the urban Chinese population. Literature review, physician and patient interviews, and decision modelling were performed to appraise current stroke care and evaluate methods to improve it. Different rehabilitation strategies were recognised and described, and their costs and health effects were estimated and compared. RESULTS: Certain universal steps in early-stage MTA could be identified. An important first step is the creation of a detailed study plan that includes evaluation criteria and may also discuss the value of a disease progression model. A second step consists of qualitative and quantitative descriptions of current treatments and new technologies. This step focuses not simply on acquiring quantitative estimates of costs, health effects and quality of care, but also on identifying areas for quality improvement. Since the literature review did not yield sufficient information, other methods (i.e., interviews) were needed to ascertain attitudes regarding usual care and behaviour. These methods provided extra insight into physician and patient preferences, insight that was used to modify the evaluation criteria. Subsequently, the new technology was described both qualitatively and quantitatively. Lastly, the costs and health effects of the treatments were compared using standard techniques (e.g., uncertainty analysis). These results identified where more information needed to be collected. CONCLUSIONS: As with later-stage MTA, there is a need and an opportunity to develop universal steps for conducting early-stage MTA. They supplement, but do not replace, the steps and techniques applied during later-stage assessments. If properly formulated, they can be used to facilitate good internal decision-making during the development phase.