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

The National Institute for Health and Care Excellence (NICE) develops Interventional Procedures Guidance (IPG) for most 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.

In September 2023, NICE published three new IPGs and made the following conclusions:

• Transurethral water-jet ablation for lower urinary tract symptoms caused by benign prostatic hyperplasia (BPH) may be used with standard arrangements for clinical governance, consent, and audit. There is a lot of good quality evidence that the procedure improves lower urinary tract symptoms caused by BPH and is safe enough;
• Removal, preservation, and reimplantation of ovarian tissue for restoring fertility after gonadotoxic treatment may be used if standard arrangements are in place for clinical governance, consent, and audit. The evidence did not raise any major safety concerns;
• The evidence for cryotherapy for chronic rhinitis is limited and includes people with different types of rhinitis. The evidence does not raise any major safety concerns, but the procedure can have complications. The short-term evidence is promising, but it is still uncertain how well the procedure works, particularly which group of patients will benefit most from the procedure and how long the effect of the treatment will last. Therefore, the procedure should be used only in research.

Health Technology Evaluations (HTE) are the 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 unmet national needs. NICE evaluates the available evidence to determine if earlier patient and system access in the NHS is appropriate while further evidence is generated.

In September 2023, NICE published three new HTEs and made the following recommendations: 

• AI technologies to aid contouring for radiotherapy treatment planning can be used in the NHS in people having external beam radiotherapy while more evidence is generated. AI technologies must be used with healthcare professional review of contours. Nine technologies are recommended for use once they have Digital Technology Assessment Criteria (DTAC) approval: AI-Rad Companion Organs RT, ART-Plan, DLCExpert, INTContour, Limbus Contour, MIM Contour ProtégéAI, MRCAT Prostate plus Auto-contouring, MVision Segmentation Service, RayStation;
• KardiaMobile 6L can be used in psychiatric services as an option to measure cardiac QT interval for adults having or about to have antipsychotic medication, while more evidence is generated only in certain clinical indications defined in the document;
• Further research is needed for Artificial intelligence (AI)‑derived software to analyze chest X‑rays alongside clinician review for suspected lung cancer in adults referred from primary care. With the available evidence, it is not possible to assess the clinical and cost benefits or risks of using the technology in the NHS. So, AI-derived software should not be used for clinical decision-making in the NHS until more evidence is available. Centers using them should generate evidence that will allow clinical and cost benefits to be assessed in the future. NICE considered 14 technologies for the assessment;

Two new clinical guidelines were published in September 2023:

• Intrapartum care – covers  care of women and their babies during labor and immediately after birth;
• Spinal metastases and metastatic spinal cord compression - includes recommendations on organising and delivering services, imaging investigations, pain management and corticosteroid therapy, radiotherapy, and invasive interventions;

Four clinical guidelines were updated in September 2023:

• Caesarean birth (pharmacotherapy-related updates);
• Cirrhosis in over 16s: assessment and management - new or updated recommendations were made for detecting and preventing bleeding from medium or large varices;
• Acute kidney injury: prevention, detection and management - recommendations on offering iodine-based contrast media to adults were amended;
• COVID-19 rapid guideline: haematopoietic stem cell transplantation.

See the full details here.

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