Med Tech-related health technology assessments from NIHR in June 2024

The National Institute for Health and Care Research (NIHR) funds valuable independent research for health and social care decision-makers in England. Reports from the Health Technology Assessment (HTA) Programme are published in the NIHR HTA Journal and inform NICE guidance. 

In June 2024, three MedTech-related assessments were published in the NIHR HTA Journal:

• Comparison of surgical or non-surgical management for non-acute anterior cruciate ligament injury, based on a pragmatic, multicentre, superiority, randomized controlled trial (ACL SNNAP). Patients in the surgical management arm underwent surgical anterior cruciate ligament reconstruction as soon as possible and without any further rehabilitation. Patients in the rehabilitation arm attended physiotherapy sessions and were only listed for reconstructive surgery on continued instability following rehabilitation. Surgery following initial rehabilitation was an expected outcome for many patients and within the protocol. It was concluded that surgical management (reconstruction) for non-acute anterior cruciate ligament-injured patients was superior to non-surgical management (rehabilitation). Although physiotherapy can still provide benefits, later-presenting non-acute anterior cruciate ligament-injured patients benefit more from surgical reconstruction without delaying a prior period of rehabilitation;
• Laparoscopic cholecystectomy versus conservative management for adults with uncomplicated symptomatic gallstones: the C-GALL RCT. The design was based on the parallel group,      multicentre randomized superiority pragmatic trial with up to 24 months of follow-up, embedded qualitative research, and within-trial cost-utility and 10-year Markov model analyses. Participants were randomized 1:1 at the clinic to receive either laparoscopic cholecystectomy or observation/conservative management. It was concluded that in the short term (up to 24 months), observation/conservative management might be a cost-effective use of National Health Service resources in selected patients, but subsequent surgeries in the randomized groups and differences in quality of life beyond 24 months could reverse this finding. Future research should focus on longer-term follow-up data and identification of the cohort of patients that should be routinely offered surgery;
• Benefits and harms of antenatal and newborn screening programs in health economic assessments based on a VALENTIA systematic review and qualitative investigation. It was concluded that there is no consistency in the selection of benefits and harms used in health economic assessments in this area, suggesting that additional methods guidance is needed. The proposed thematic framework can be used to guide the development of future health economic assessments evaluating antenatal and newborn screening programs.

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