Med Tech-related HTAs in Wales published in July 2023

Health Technology Wales (HTW) is a national body working to improve the quality of care in Wales. It is funded by Welsh Government and hosted within NHS Wales but independent of both. HTW covers medical devices, diagnostics, procedures, psychological therapies, models of care, and social care support, excluding pharmaceuticals.

Anyone can suggest a topic, and HTW also performs active horizon scanning. HTW uses a staged process of assessment by developing three types of documents. The topic exploration report (TER) aimed to assess whether there is enough available evidence to proceed with a full appraisal and whether the topic meets the appraisal selection criteria. Based on the TER conclusions, HTW's Assessment Group decides whether to progress this topic further. If yes, the following two documents are developed: Evidence Appraisal Report (EAR) and Guidance (GUI). 

Recommendations are not mandatory; the status of HTW guidance is "adopt or justify," meaning that the local health board and other relevant bodies are expected to report on how they have considered the appraisal and guidance. If they have chosen not to adopt HTW guidance, they are asked to outline their rationale and justify their decision.

In July 2023, one full appraisal was completed on wearable cardioverter defibrillators for people at risk of cardiac death. HTW made different recommendations depending on the clinical indications:

• For patients who require an implantable cardioverter defibrillator to be explanted and there is a delay to re-implantation, the use of wearable cardioverter defibrillators is considered clinically and cost-effective, and HTW supports their routine use for this indication;
• For patients in whom there is an unavoidable delay in decision-making about the possible need for a permanent implantable cardiac defibrillator, there is uncertainty around the benefits of wearable cardioverter defibrillator devices, and they do not appear to be cost-effective. HTW does not recommend routine use for this population.

In July 2023, HTW decided to develop a full appraisal on radiofrequency renal denervation for the treatment of resistant hypertension based on TER recommendations. It was concluded that there is also a lack of existing evidence synthesis regarding other outcomes beyond blood pressure. Although there might be sources available to evaluate other outcomes, such as cardiovascular morbidity and mortality, it is possible that they might not be as well-evidenced as blood pressure. In addition, it is important to investigate the current and available care options for these patients in Wales. Although studies evaluating the cost-effectiveness in the UK have been identified, if this topic proceeds to appraisal, an economic evaluation would be needed to clarify the cost-effectiveness of this procedure in Wales and whether de novo economic modeling is feasible.

See the full details here.

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