Decision-making by the NICE Interventional Procedures Advisory Committee.

Area of Science:

• Health Services Research
• Medical Technology Assessment
• Evidence-Based Medicine

Background:

• The National Institute of Health and Care Excellence (NICE) Interventional Procedures Advisory Committee uniquely excludes cost from its recommendation considerations.
• This committee evaluates interventional procedures, assigning one of four recommendations: Standard Arrangements, Special Arrangements, Research Only, or Do Not Do.

Purpose of the Study:

• To analyze the evidence base and trends in recommendations made by the NICE Interventional Procedures Advisory Committee.
• To understand the factors influencing the type of recommendation given to interventional procedures.

Main Methods:

• A quantitative content analysis of 496 published Interventional Procedure Guidances (IPGs) from 2003 to 2018.
• Data extraction by two independent researchers, followed by tabulation, descriptive statistics, and regression analyses.

Main Results:

• Over 50% of IPGs received a 'Standard Arrangements' recommendation, but this proportion decreased over time.
• The evidence threshold for recommendations increased, with 'Standard Arrangements' requiring larger patient numbers and higher evidence levels.
• Regression analyses confirmed that the year of recommendation, patient numbers, and evidence levels significantly influenced the recommendation outcome.

Conclusions:

• The likelihood of achieving a 'Standard Arrangements' recommendation is declining, likely due to increasingly stringent evidential requirements.
• These findings differ from other NICE committees where cost and statistical superiority are key drivers.
• The study highlights a trend towards more rigorous evidence demands for interventional procedures within the NHS.