Med Tech-related health technology assessments from NIHR in October 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 the National Institute for Health and Care Excellence (NICE) guidance. 

In October 2024, seven Med Tech-related assessments were published in the NIHR HTA Journal:

• Genedrive kit for detecting single nucleotide polymorphism m.1555A>G in neonates and their mothers, based on a systematic review and cost-effectiveness analysis. This early value assessment concluded that the Genedrive MT-RNR1 ID Kit has the potential to identify the m.1555A>G variant and to be cost-effective. The Genedrive MT-RNR1 ID Kit dominates the current standard of care over the lifetime, as it is less costly and more effective. For a 50-year time horizon, the Genedrive MT-RNR1 ID Kit was also the dominant strategy. For the 10-year time horizon, the incremental cost-effectiveness ratio was estimated to be £103 per quality-adjusted life-year gained. Nevertheless, as anticipated, there is insufficient evidence to conduct a full diagnostic assessment of the clinical effectiveness and cost-effectiveness of the Genedrive MT-RNR1 ID Kit in neonates directly or in their mothers;
• Timing of stoma closure in neonates based on the mixed-methods study (ToSCiN). It was concluded that a trial of ‘early’ compared to ‘late’ stoma closure in neonates is feasible and is important to families and health professionals. The population of eligible babies in the UK is sufficient for such a trial. The recommendations were made for future trial design;
• Interventions for people with perceptual disorders after stroke based on the PIONEER scoping review, Cochrane systematic review, and priority setting project. It was concluded that evidence informing interventions for perceptual disorders after stroke is limited for all senses;
• Vein bypass first vs. best endovascular treatment first revascularisation strategy for chronic limb-threatening ischaemia due to infra-popliteal disease was assessed based on the superiority, open, pragmatic, multicenter, phase III randomized trial (BASIL-2). It was concluded that the best endovascular treatment-first revascularization strategy was associated with better amputation-free survival, which was largely driven by fewer deaths. Overall, the economic evaluation results suggest that the best endovascular treatment-first dominates vein bypass-first in the cost-effectiveness and cost-utility analyses as it was less costly and more effective than a vein bypass-first strategy;
• A systematic review and cost-effectiveness analysis concerning MRI software and cognitive fusion biopsies in people with suspected prostate cancer. It was concluded that software fusion biopsies may be associated with increased cancer detection in relation to cognitive fusion biopsies, but the evidence is at high risk of bias. Sufficiently powered, high-quality studies are required. The economic analysis suggests incremental cost-effectiveness ratios for software fusion biopsy versus cognitive fusion are within the bounds of cost-effectiveness (£1826 and £5623 per additional quality-adjusted life-year with or with concomitant systematic biopsy, respectively). However, cost-effectiveness results should be interpreted with caution given the limitations of the diagnostic accuracy evidence; 
• Transperineal biopsy devices in people with suspected prostate cancer were assessed based on a systematic review and economic evaluation. The following key conclusions were made: 
  • Local anesthetic transperineal (LATP) prostate biopsy is equally efficient at detecting prostate cancer as transrectal ultrasound-guided prostate biopsy (TRUS) under local anesthesia, but it may be better with a freehand device; 
  • LATP prostate biopsy is associated with urinary retention-type complications, whereas TRUS biopsy under local anesthesia has a higher infection rate;
  • LATP prostate biopsy with a freehand device appears to meet conventional levels of cost-effectiveness compared with TRUS prostate biopsy under local anesthesia.
• Alitretinoin versus phototherapy as the first-line treatment in adults with severe chronic hand eczema based on the prospective, multicenter, open-label, two-arm parallel group, adaptive randomized controlled trial (ALPHA) with one planned interim analysis, and an economic evaluation. It was concluded that as a first-line therapy, alitretinoin showed more rapid improvement and superiority to ultraviolet therapy at week 12. This difference was not observed at later time points. Alitretinoin is cost-effective at weeks 12 and 52. Ultraviolet therapy is cost-effective after 10 years, with a high degree of uncertainty. The hand eczema severity index may be a useful primary outcome measure for hand eczema trials. ALPHA results will inform future trials. The treatment compliance for ultraviolet therapy was poor.

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