Published health technology assessments in Wales in Q4 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, models 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.

Three topic apprisals were completed in the Q4 of 2022 with the publication of the Evidence Appraisal Report (EAR) and Guidance (GUI).

One technology received positive recommendations:

• The evidence supports the routine adoption of continuous topical oxygen therapy to treat patients with chronic non-healing and complex diabetic foot ulcers. The use of continuous topical oxygen therapy (TOT), in addition to the standard of care, increases the number of wounds with complete wound healing and reduces the wound area and time to healing, as compared with the standard of care alone. Economic analysis indicates that the use of continuous TOT results in a greater benefit to patients at a lower cost compared with standard care. Cost savings of £211 per patient are estimated. When considering the projected prevalence of chronic non-healing and complex diabetic foot ulcers over the next five years in Wales, this could translate to total cost savings of £8,637.

Two technologies were not recommended for routine adoption:

• The evidence does not support the routine adoption of left atrial appendage occlusion (LAAO) in adults with non-valvular atrial fibrillation who have contraindications to oral anticoagulation. There are no comparative studies of left atrial appendage device occlusion compared with standard care in adults with non-valvular atrial fibrillation in whom oral anticoagulation is contraindicated, although non-comparative observational studies suggest that LAAO reduces the rate of ischaemic stroke. The cost-utility analysis concludes that while LAAO, in addition to standard care, may be more effective than standard care with aspirin alone, it is cost-incurring and not cost-effective with an ICER (incremental cost-effectiveness ratio) of £42,302 per QALY (quality-adjusted life year);
• The evidence partially supports the adoption of virtual reality (VR) interventions for the management of pain and anxiety in adults and children undergoing medical procedures, but the evidence is insufficient to support routine adoption. The use of VR reduces pain and anxiety associated with a range of medical procedures as compared with standard care and is well tolerated. While there is the potential for cost savings through a reduction in the use of analgesics, sedation, or anesthesia, the evidence to support this is currently limited. HTW would encourage the gathering of further evidence to define the economic and clinical impact of virtual reality in more detail.

In Q4 of 2022, HTW's Assessment Group evaluated the following topics but decided not to proceed with the full appraisals:

• Virtual wards to deliver care in community settings. There is uncertainty within the evidence based on variability in models of service delivery and relevant patient populations;
• Genetic testing for prostate cancer care, including pharmacogenetics testing to inform prostate cancer treatment;
• Adjunctive autofluorescence imaging of oral mucosal abnormalities to identify malignancy or premalignancy, including, but not limited to, OralID. The evidence base was not sufficient for a full appraisal;
• Geniculate artery embolisation to relieve long-term pain for adults with knee osteoarthritis. There was a lack of evidence to inform decision-making.

See the full details here.

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