Highly Specialised Technologies (UK NICE)

Highly specialised technologies (HST) are interventions that address very rare conditions. In the UK, these technologies are assessed by a dedicated, specialist HST committee, who employ a broader assessment framework than that used for single technology appraisals (STAs). The HST framework at NICE recognises the difficulty in undertaking clinical trials for these therapies and the resulting uncertainty in cost-effectiveness estimates, as well as the potential impact of HSTs beyond direct health benefits, the impliations for service delivery, and the difficulties for manufacturers to recoup the large associated R&D costs.
A more generous cost-effectiveness threshold of £100,000 per QALY gained (rising to £300,000 per QALY gained in specific circumstances) is applied to HSTs. Outcome-based managed access agreements are often feasible, given the small populations of treated patients that allow for close follow-up. Key criteria for an intervention to be considered an HST include the size of the target patient group, the nature of the condition, the need for a specialised service supported by national commissioning, and the cost of the technology itself.