Published health technology assessments in Wales in Q1 of 2022

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, model of care, and social care support, excluding pharmaceuticals.

HTW uses a staged process of assessment by developing three types of documents. Anyone can suggest a topic, and HTW also performs active horizon scanning. 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.

One topic, Transcranial magnetic stimulation to treat people with treatment-resistant major depression, was completed in  Q1 of 2022 with the publication of EAR and Guidance. It was concluded that the use of repetitive transcranial magnetic stimulation (rTMS) in treatment-resistant major depression is partially supported by the evidence. The use of rTMS is well-tolerated, leads to a medium-term (up to three months) reduction in depression score, and improves response and remission rates compared with sham treatment. Further research is recommended to better determine the case for cost-effectiveness, to establish the long-term efficacy of rTMS, including potential maintenance therapy, and to determine the appropriate placement of rTMS in the NHS Wales treatment pathway.

Eleven MedTech-related TERs were published in Q1 of 2022:

• Left atrial appendage occlusion in patients with atrial fibrillation: based on the TER conclusions, HTW's Assessment Group decided to progress this topic further;
• Active middle ear implants: HTW's Assessment Group decided not to progress this topic further;
• Use of structural neuroimaging (CT or MRI) for diagnosis of dementia: based on initial topic exploration, HTW's Assessment Group decided not to progress this topic further;
• Active transcutaneous bone conduction hearing implants: based on initial topic exploration, HTW's Assessment Group decided not to progress this topic further;
• Selective internal radiation therapy for metastatic colorectal cancer: based on initial topic exploration, HTW's Assessment Group decided not to progress this topic further;
• Cytoreduction surgery with hyperthermic intraoperative peritoneal chemotherapy: based on initial topic exploration, HTW's Assessment Group decided not to progress this topic further;
• Portable devices that analyze mandibular movements for sleep apnoea diagnosis: HTW's Assessment Group decided not to progress this topic further as the evidence base was not sufficient for a full appraisal;
• Radiofrequency renal denervation for the treatment of resistant hypertension: based on initial topic exploration, HTW's Assessment Group decided to proceed with developing an Evidence Appraisal Report (EAR) and Guidance on this topic;
• Neuropad for screening and detection of early signs of diabetic peripheral neuropathy: HTW's Assessment Group decided not to progress this topic to full appraisal because NICE is currently developing guidance on this technology;
• LiverMultiScan for the diagnosis and staging of non-alcoholic fatty liver disease (NAFLD): HTW's Assessment Group decided not to progress the topic further as NICE guidance is currently in development;
• CaRi-Heart for measurement of coronary inflammation in the investigation and management of coronary artery disease: HTW's Assessment Group decided not to progress this topic further as the evidence base is still developing.

See the full details here.

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