The National Institute for Health and Care Excellence (NICE) is an executive non-departmental public body of the Department of Health and Social Care in England that publishes guidelines in four areas: These appraisals are based primarily on evidence-based evaluations of efficacy, safety and cost-effectiveness in various circumstances.It serves both the English NHS and the Welsh NHS. It was set up as the National Institute for Clinical Excellence in 1999, and on 1 April 2005 joined with the Health Development Agency to become the new National Institute for Health and Clinical Excellence (still abbreviated as NICE). Following the Health and Social Care Act 2012, NICE was renamed the National Institute for Health and Care Excellence on 1 April 2013 reflecting its new responsibilities for social care, and changed from a special health authority to an executive non-departmental public body (NDPB).NICE was established in an attempt to end the so-called postcode lottery of healthcare in England and Wales, where availability of treatments depended on the NHS Health Authority area in which the patient happened to live, but it has since acquired a high reputation internationally as a role model for the development of clinical guidelines. One aspect of this is the explicit determination of cost–benefit boundaries for certain technologies that it assesses. NICE also plays an important role in pioneering technology assessment in other healthcare systems through NICE International, established in May 2008 to help cultivate links with foreign governments. NICE International has received financial support from the Bill & Melinda Gates Foundation and Rockefeller Foundation.
Objectives The rapid evolution of digital health technologies (DHTs) presents distinct challenges for health technology assessment (HTA). Existing HTA frameworks, largely designed for conventional health interventions, may not sufficiently address these unique complexities. This scoping review provides an overview of existing assessment frameworks for DHTs, analyzing their purpose and the guidance they offer within the domains of the EUnetHTA Core Model.Methods The review followed the Joanna Briggs Institute methodology and PRISMA-ScR guidelines. The literature was identified through searches in PubMed and Embase, covering publications from 2015 to 2024 in English or German, and was complemented by a manual hand search. The studies were screened and analyzed using Covidence, with data categorized inductively based on the EUnetHTA Core Model domains.Results Of 3,576 screened records, 15 met inclusion criteria; an additional 45 frameworks were identified through hand searching, resulting in a total of 60 frameworks. Most frameworks focused on digital health applications (68 percent), while only a few addressed technologies such as artificial intelligence (2 percent). The frameworks primarily provide guidance on assessment, with varying focus on evidence requirements. The domains of the EUnetHTA Core Model were variably represented across the frameworks. Technical characteristics were most frequently addressed, while ethical, legal, and organizational domains received limited attention.Conclusions This review highlights the diversity of existing frameworks for DHT assessment. This emphasizes the potential relevance of a future standardized framework that contains explanations of the methodological approach to the assessment of DHTs and is modularly customizable depending on the type of technology.
Healthcare decision-making often assumes equal value for quality-adjusted life years (QALYs) across patient groups, yet societal preferences suggest that the value of a QALY may vary with characteristics such as age. Evidence indicates some willingness to prioritise child health gains, though findings are inconsistent. This study used person trade-off (PTO) to estimate the relative social value of different types of health gains for children and adolescents (aged 0–24 years) compared with adults. A representative Australian sample aged 16 years and above (n = 2098) completed an online survey comparing life extension and quality-of-life improvements for different ages. A ‘chaining’ approach tested response consistency, and logistic regression explored associations between PTO choices and respondent characteristics. Attitudinal questions and open text responses provided additional insights. PTO responses show that health gains for children and adolescents (4–24 years) are generally valued more highly than those for adults (age 40 or 55 years), with weights ranging from 1 to 1.3. For very young children, findings vary by health gain type: life extensions for infants (1 month or 2 years) are weighted lower, but pain alleviation is higher (weights ≥ 1.2). Qualitative and attitudinal data reveal diverse views, with many opposing age-weighting. Younger respondents and those with young children prioritise children more, while older and female participants preferred equal treatment. The relative value of child QALY gains varies by age of the child, by health gain type, and by adult comparison age. While alleviating children’s pain is strongly supported (weights ≥ 1.2), overall views are polarised, highlighting the complexity of age-based prioritisation.
The International Network for Social Intervention Assessment (INSIA) is a partnership of organizations that produce, support, and use evidence synthesis in social care. It emerges as a pivotal entity that supports evidence-informed social care decision-making. The paper argues for the importance of the production and use of trustworthy evidence synthesis in social care to inform and guide policy and practice. We articulate INSIA's position in the global field of social intervention assessment, list the vision and aims of INSIA as a network for promoting and enabling the production and use of evidence synthesis in social care, and issue a call to action, inviting other organizations to join this work.
Background:Ovarian hyperstimulation syndrome is a significant complication of fertility treatment, where the ovaries become enlarged if they are overstimulated, resulting in fluid leakage. Ovarian hyperstimulation syndrome can be classified as mild, moderate or severe. Symptoms vary dependent on severity but can include abdominal swelling, pain, nausea and vomiting, and shortness of breath. Treatment typically consists of monitoring initially, with active intervention if the condition progresses to a severe state, requiring hospitalisation. This study explored the acceptability and feasibility of outpatient paracentesis, and of gonadotropin-releasing hormone antagonists, as early interventions for ovarian hyperstimulation syndrome. Methods:We conducted qualitative semi-structured interviews with healthcare professionals from fertility clinics (n = 8) and patients who had experienced ovarian hyperstimulation syndrome (n = 10) across six United Kingdom fertility clinics. Interviews explored views on the proposed treatment protocols, and potential barriers and facilitators to randomised controlled trials evaluating these treatments. Results:Both healthcare professionals and patients were supportive of the proposed trials. Key findings included that healthcare professionals recommended clarity on patient eligibility, hospitalisation criteria and consent procedures. Patients expressed a desire to be given more detailed information about potential trials and had mixed opinions on self-monitoring. There were some concerns from both parties about treatment risks, particularly the paracentesis. Healthcare professionals noted a shift to more preventative practice due to the COVID-19 pandemic. Conclusions:Outpatient paracentesis and gonadotropin-releasing hormone antagonists were perceived as promising interventions. Potential concerns and recommendations around both acceptability and feasibility were raised, which were used to refine the treatment protocols for the Shaping and Trialling Outpatient Protocols for Ovarian Hyperstimulation Syndrome trial. Funding:This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR128137.
