POSB271 Is NICE Becoming More Efficient in the Duration of the Highly-Specialised Technologies (HST) Process?

Abstract

To determine whether the National Institute for Health and Care Excellence (NICE) is becoming more efficient in evaluating medicines and treatments through the Highly-Specialised Technologies (HST) process, by determining whether the length of the HST process has shortened. As per NICE targets, the HST process should take 168 days from submission. All completed HST evaluations published by NICE between November 2014 and February 2021 were included. Fourteen HST evaluations were analysed to understand the process timing, from preparation of the scope to the publication of the final guidance, as well as the publication of Evaluation Consultation Documents (ECDs). To understand whether NICE has become more efficient in this process over time, the 14 HST evaluations were split between those with final scope published before and after the August 2017 update. Seven HST guidance’s with final scope dates prior to August 2017, and seven HST guidance’s after that date, were identified. Overall, the median days from final scope to final guidance is 352 days (range 234 – 1169 days). For HST guidance prior to August 2017, the median days from final scope to guidance is 348 days (range 234 - 944 days), compared to 385 days (range 274 – 1169 days) for HST guidance after August 2017. Of the seven pre-August 2017 HST guidance’s, three required the publication of more than one ECD, compared to 0 in the post-August 2017 HST guidance process. The research showed that NICE are clearly far from their 168-day target for the HST process. Despite the reduced need for the publication of multiple ECD’s, the median HST duration has slightly increased since the program’s conception in 2012. There is a negative health consequence for patients, whose access to potentially life-changing medicines is being slowed. An upcoming HST process update should aim to reduce inefficiencies.