OBJECTIVES:

The NICE Medical Technologies Evaluation Programme (MTEP) evaluates the case for adopting medical technologies that are likely to reduce costs for equivalent or improved outcomes in the NHS. We aimed to assess the determining factors in MTEP decision-making.

METHODS:

MTEP guidance published before April 2018 was reviewed. Adoption decisions, cost-estimates versus comparator(s) and reasons for recommendation were extracted.

RESULTS:

Of the 37 MTEP recommendations, 29 were positive and 6 were negative (1 unclear, 1 withdrawn). Twenty-seven positive recommendations reported per-patient costs (mean savings £2,107) and 5/29 positive recommendations (17%) reported some cost-incurring estimates. Of the reasons supporting each positive recommendation, the most common were improved clinical efficacy (n=26, 90%), safety (n=19, 66%), or resource use (n=21, 72%) versus comparator(s). Unmet need, reduced staff resource, ease of use, quality of life impact and patient factors were less commonly reported (<45% of positive recommendations each). Of the 6 negative recommendations, there were insufficient data to inform cost modelling in 1 (17%), and 2 (33%) reported some cost-incurring estimates. Of the remaining 3 assessments, which only reported cost-neutral/-saving estimates, the Committee considered that the cost-modelling was uncertain. Five negative recommendations reported per-patient costs (mean savings £754). The Committee cited issues regarding clinical efficacy evidence and resource use as reasons supporting a negative recommendation in 6 (100%) and 2 (33%) assessments, respectively.

CONCLUSIONS:

On average, technologies with positive recommendations achieved greater cost-savings than those with negative recommendations. Both positive and negative recommendations seem to be mostly frequently supported by clinical evidence, regardless of cost implications, suggesting that clinical efficacy is the primary decision-making factor.