The NICE Evidence Standards Framework for digital health and care technologies - Developing and maintaining an innovative evidence framework with global impact

Objective

In 2018, the UK National Institute for Health and Care Excellence (NICE), in partnership with Public Health England, NHS England, NHS Improvement and others, developed an evidence standards framework (ESF) for digital health and care technologies (DHTs). The ESF was designed to provide a standardised approach to guide developers and commissioners on the levels of evidence needed for the clinical and economic evaluation of DHTs by health and care systems.

Methods

The framework was developed using an agile and iterative methodology that included a literature review of existing initiatives and comparison of these against the requirements set by NHS England; iterative consultation with stakeholders through an expert working group and workshops; and questionnaire-based stakeholder input on a publicly available draft document.

Results

The evidence standards framework has been well-received and to date the ESF has been viewed online over 55,000 times and downloaded over 19,000 times.

Conclusions

In April 2021 we published an update to the ESF. Here, we summarise the process through which the ESF was developed, reflect on its global impact to date, and describe NICE’s ongoing work to maintain and improve the framework in the context for a fast moving, innovative field.

Lung-cancer reduction from smoking cessation and radon remediation: a preliminary cost-analysis in Northamptonshire, UK

Domestic radon levels in parts of the United Kingdom are sufficiently high as to increase the risk of lung-cancer among residents. Public health campaigns in the county of Northamptonshire, a designated radon Affected Area with 6.3% of homes having average radon levels in excess of the UK Action Level of 200 Bq m(-3), have encouraged householders to test for radon and then, if indicated to be necessary, to carry out remediation in their homes. These campaigns have been only partially successful, since to date only 40% of Northamptonshire houses have been tested, and only 15% of those householders finding raised levels have proceeded to remediate. Those who remediate have been shown to have smaller families, to be older, and to include fewer smokers than the average population, suggesting that current strategies to reduce domestic radon exposure are not reaching those most at risk. During 2004-2005, the NHS Stop-Smoking Services in Northamptonshire assisted 2847 smokers to quit to the 4-week stage, the 15% (435) of these 4-week quitters remaining quitters at 1year forming the subjects of a retrospective study considering whether smoking cessation campaigns contribute significantly to radon risk reduction. Quantitative assessment of the risk of lung-cancer among the study population, from knowledge of the individuals' age, gender, and smoking habits, together with the radon levels in their homes, demonstrates that smoking cessation programmes have significant added value in reducing the incidence of lung-cancer in radon Affected Areas, and contribute a substantially greater health benefit at a lower cost than the alternative strategy of reducing radon levels in the smokers' homes, while they remain smokers. Both radon remediation and smoking cessation programmes are very cost effective in Northamptonshire, with smoking cessation being significantly more cost effective, and these are potentially valuable programmes to drive health improvements through promotion of the uptake or environmental management for radon in the home.

How well are we doing? Metabolic control in patients with diabetes

OBJECTIVE

To compare the present level of metabolic control in children and adolescents with insulin-dependent diabetes mellitus (IDDM) attending Brisbane paediatric diabetes clinics with published overseas data.

METHODOLOGY

Blood HbA1c concentrations, population characteristics, current treatment practices and short-term complications were recorded in all patients, aged 19 years and under, attending the diabetes clinics of the two Brisbane Children's Hospitals or the private practice of one of the authors (MJT) in the first quarter of 1998.

RESULTS

Two hundred and sixty-eight patients were assessed (M/F 142/126). Ages ranged from 1 to 19 years (mean 11. 2 years); duration of IDDM was 0-16 years (mean 4.4 years); and 141 (53%) were pubertal. Of those aged less than 13 years, only 4% had more than two injections daily. Insulin doses (U/kg/day) rose with increasing age. Larger doses were required in regimens involving more than two injections per day than those involving one to two injections per day. Ketoacidosis or severe hypoglycaemia in the last 3 months were reported in eight (2.7%) and 17 (6.3%) of patients, respectively. Mean HbA1c (+/- SD) was 8.6 +/- 1.4% (range 5.2-14.0%), with 33% of children having a HbA1c concentration < 8%. HbA1c concentrations were significantly related (P < 0.05) to insulin dose and to duration of diabetes, but not to severe hypoglycaemia, ketoacidosis, age, frequency of injections, or number of clinic visits per year. Mean HbA1c concentration was significantly higher (P < 0.05) in those children in puberty (8.7 +/- 1.5%) than in those not in puberty (8.5 +/- 1.2%).

CONCLUSION

Only 33% of patients had a HbA1C concentration less than 8% and 6.3% had a severe hypoglycaemic episode in the 3 months. These results are similar to published overseas data.