Health technology guidance

Health technology guidance sets out an assessment body's recommendations, the evidence behind them and what they mean for practice. Preparing it involves drafting, editorial checks and accessible information for patients and the public.

NICE guidance programmes

In 2013, England's National Institute for Health and Care Excellence (NICE) developed guidance on health technologies through its Centre for Health Technology Evaluation (CHTE). ¹ NICE described its recommendations as developed by independent, unbiased advisory committees using the best available evidence and the views of experts, patients, carers and industry. ² Technologies included medicines, devices, diagnostic techniques, surgical procedures, other therapeutic technologies, systems of care and screening tools. ¹ Its four technology-guidance programmes differed in scope. ¹

• Technology appraisals assessed clinical and cost effectiveness of new pharmaceutical and biopharmaceutical products and some procedures, devices and diagnostic agents. The National Health Service (NHS) in England and Wales was legally obliged to implement recommendations, usually within three months of publication.
• Diagnostics technologies guidance assessed technologies that could improve outcomes but were likely to increase overall NHS costs, concentrating on pathological tests, imaging, endoscopy and physiological measurement. Uses included diagnosis, clinical monitoring, screening, treatment triage, staging disease progression and risk stratification.
• Medical technologies guidance assessed technologies that might offer similar outcomes at lower cost or improved outcomes at the same cost, including treatment devices, technologies supporting independence and diagnostic devices or tests.
• Interventional procedures guidance assessed safety and efficacy of mainly new procedures involving incision, puncture, entry into a body cavity or ionising, electromagnetic or acoustic energy. It did not assess cost effectiveness.

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Document structure

NICE guidance set out committee recommendations and the evidence and views considered. ¹ It generally followed this order. ¹

1. Recommendations.
2. The technologies and their uses.
3. A summary of clinical and cost-effectiveness evidence.
4. The committee's discussion and interpretation of the evidence underpinning its recommendations.

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Drafting and editorial responsibility

In 2013, five senior medical editors edited all CHTE guidance, each leading appraisals for one technology-appraisal committee and one other programme. ³ Technical analysts drafted the documents; editors took responsibility for the consultation and final guidance for their committee and programme, usually attending committee meetings as observers. ³ Editing helped prevent mistakes, omissions and ambiguities and made complex material understandable to professionals and the public. ^{2, 3}

The editors received basic health-economics training to understand terminology and evaluation methods, avoid jargon, explain complex information and communicate with CHTE colleagues. ³ They edited and proofread, and for some programmes checked facts against supporting material such as manufacturer submissions and independent technology assessments. ³ Copyediting covered sense, clarity, consistency, accuracy, grammar and house style. ³

Editors checked that recommendations were clear, unambiguous, within scope and supported by the evidence and the committee's considerations, and could suggest wording or raise wider issues. ³ They checked consistency with other NICE guidance, ensured later changes reached all relevant sections and checked accepted terminology for groups protected by equalities legislation. ³ They prepared digital publication and checked the live website. ³

Editors owned the associated editorial processes, maintained editing notes and checklists within production quality control, and collaborated on templates. ⁴ They often handled several documents at different stages under very tight deadlines. ⁴

Information for the public

In 2013, NICE met its obligation to make guidance accessible to NHS service users by producing a lay translation of each clinical guidance document and quality standard, called information for the public. ⁵ Editors wrote and edited it. ⁵ A technology-appraisal leaflet covered the following, in order. ⁵

1. What NICE said about the technology, who could receive it and why the recommendations were made.
2. How the technology worked and the condition it treated.
3. What the recommendations meant for patients, followed by up to five organisations offering information and support to people with the condition and their carers.

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