The number and range of technologies that the National Institute for Health and Care Excellence (NICE) evaluates has never been greater, and with that comes an increasing requirement for capacity. However, not all technologies need the full intensity of the current standard evaluation process. This presents an opportunity to differentiate evaluation processes, and in doing so release capacity for more evaluations. NICE has embarked on a project to develop proportionate appraisal processes, allowing promising medicines to move through refined processes that better match the specific needs of individual evaluations.

The proportionate approach to technology appraisals (PATT) project was initiated in June 2022. Multiple work strands were established to develop and test potential proportionate approaches, focusing mainly on streamlined approaches for appraisals in which a lighter-touch approach is sufficient. By creating an accountability framework which empowered staff across NICE, new processes were developed using test-and-learn principles: piloting key concepts using retrospective reviews and live appraisals and adjusting the approach based on their findings. The impacts of each approach on NICE, on stakeholders and on the individual appraisals were monitored and assessed.

The project has identified a range of procedural, methodological and operational improvements across the NICE technology appraisal process. Substantial efficiencies have been found, including consolidation of activities, reducing duplication of effort and minimizing disproportionate steps. The test-and-learn approach has proved successful, both in rapidly identifying unsuccessful ideas and in refining and adjusting processes in light of new information and challenges.

The proportionate approach to technology appraisals project represents an important part of improving and streamlining NICE’s approach to health technology assessment, reflecting the increasing demands on the program. Developing proportionate approaches allows efficient use of limited evaluation resources to continue supporting rapid, evidence-based access to innovative technologies. The project also provides a valuable demonstration of an agile, flexible approach to process improvement, paving the way to rapid, dynamic updates in the future.