Med Tech-related technology assessments and clinical guidelines from NICE in February 2023

In February 2023, NICE published two Interventional Procedures Guidance (IPG):

• Transvenous obliteration for gastric varices;
• Biodegradable spacer insertion to reduce rectal toxicity during radiotherapy for prostate cancer.

IPG is developed for most of the novel interventional procedures entering the English market. The program focuses solely on clinical evidence. Recommendations may vary from "for research only" to "for use with standard arrangements for clinical governance, consent, and audit." Recommendations are not binding, although they are followed by providers and commissioners.

NICE made the following conclusions:

• Evidence on the safety and efficacy of transvenous obliteration of gastric varices is adequate in the short term but limited in the long term. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research;
• Evidence on the safety and efficacy of biodegradable spacer insertion to reduce rectal toxicity during radiotherapy for prostate cancer is limited in quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.

In February 2023, NICE published the first Health Technology Evaluation (HTE) for medical technologies. HTE is a new type of NICE guidance that uses the Early Value Assessment (EVA) approach to provide rapid conditional recommendations on promising health technologies that have the potential to address the unmet national need. NICE evaluates available evidence to determine if earlier patient and system access in the NHS is appropriate while further evidence is generated.

NICE recommended four guided self-help digital cognitive behavioural therapy (CBT) to be used as an initial treatment option for children and young people (aged 5 to 18) with mild to moderate symptoms of anxiety or low mood while evidence is being generated. These technologies can be used once they have Digital Technology Assessment Criteria (DTAC) approval from NHS England. The technologies are:

• Lumi Nova (by BfB labs);
• Online Social anxiety Cognitive therapy for Adolescents (by OSCA);
• Online Support and Intervention for child anxiety (by OSI);
• Space from anxiety for teens, space from the low mood for teens, space from low mood and anxiety for teens (by Silvercloud).

The MedTech Innovation Briefings (MIBs) is the advice program of NICE for innovative technologies. It provides an overview of clinical effectiveness, safety, and cost. It does not offer formal guidance, and it, therefore, does not provide any recommendations. The two new MIBs published in February 2023 are:

• LIVERFASt for assessing and monitoring liver fibrosis, activity, and steatosis in people with non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH), hepatitis B and hepatitis C;
• Ambu aScope 4 RhinoLaryngo for visualizing upper airway anatomy during rhino-laryngoscopy procedures in adults.

One new clinical guideline, “Barrett's oesophagus and stage 1 oesophageal adenocarcinoma monitoring and management,” was published in February 2023, including recommendations on endoscopic and non-endoscopic treatment. One clinical guideline, “Cardiovascular disease: risk assessment and reduction, including lipid modification,” was updated.

See the full details for guidance here and for MIBs here.

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