The NICE Conference 2025: A celebration of 25 years of NICE

The National Institute for Health and Care Excellence (NICE) is 25 years old. Since its inception NICE has been busy setting standards for healthcare delivery, publishing guidance on public health, and assessing and making recommendations on new pharmaceuticals and health technologies. In the process NICE has won international respect and influence. NICE guidelines and methodologies are used internationally and other countries have held NICE up as a gold-standard for developing their own healthcare guidelines and systems. Last year Spain, for example, leaned heavily on how NICE works when it remodeled its health system ahead of the European Union Health Technology Regulation, which came into force in January.

While NICE is a highly respected organization, it does face its share of criticism. This often stems from differing opinions over certain decisions to not approve innovative treatments that are considered too costly for the National Health Service (NHS). Balancing innovation, affordability and health equity is not an easy task, but these are the challenges that NICE will continue to navigate in the future.

NICE knows this and its 1 day conference – The NICE Conference 2025– celebrating its first 25 years, showcased how it wants to step up its collaboration with the health and social care industry to make the most of innovation while striving to deliver a more equitable approach to health and social care provision.

Safe spaces for health technology assessment development

A session titled “Driving creative solutions in health technology assessment (HTA)” discussed how the Health Technology Assessment Innovation Laboratory (HTA Lab) that NICE leads is enabling it to develop more creative solutions to complex HTA problems without impacting live projects. The HTA Lab offers “a safe space” for creating solutions in collaboration with partners and stakeholders. The HTA Lab is useful for:

• Evaluation of existing methods to assess new therapies by looking at the existing scope of the method, improving and innovating them
• Increasing the pace of innovation, given the recent surge in the range of problems and portfolios
• The HTA Lab enables co-development between NICE, academia and industry, and is a way to test methods away from HTA assessments
• The HTA Lab has been a place to develop methods to prepare for assessment of disease modifying drugs to treat Alzheimer’s disease, virtual wards/home based hospital care, and using Artificial Intelligence (AI) for evidence generation

Incentives for partnerships

Other examples of this drive for more creative solutions include a collaboration between NICE, NHS England and other stakeholders on a new model for evaluating and purchasing antimicrobials. Historically, it has been difficult for pharmaceutical companies to see a return on their investment in developing antimicrobials given tight controls restricting the use of antimicrobials in order to control the spread of antimicrobial resistance. NICE and NHS England have partnered a national action plan for antimicrobial resistance to test incentives for pharmaceutical companies to invest in developing new antimicrobials. The pilot evaluated different ways of paying for antimicrobials – including subscription styled contracts that pay companies a fixed annual fee based on an HTA assessment of their product’s value to the NHS instead of the volumes of product used.

The conference heard how the introduction of this subscription model has showcased the UK as a launch market for antimicrobial therapies. Given the growing global interest in antimicrobials, the work has helped to demonstrate the UK as a trailblazer for innovation. The initiative still requires wider global uptake of similar methods to drive research in antimicrobials but the UK is at the forefront of this. Pharmaceutical companies that are interested in getting involved can engage with the HTA Lab via the Association of the British Pharmaceutical Industry.

The NICE Conference 2025 showcased several other examples of innovation – particularly the potential impacts of medical technology (medtech) companies, AI, and how to maximize their potential benefits for healthcare systems and patients.

The conference left little doubt about how important partnerships with NICE will be – we heard for example, how the Medicines and Healthcare products Regulatory Agency (MHRA) and NICE are working together. NICE delivered a clear message that the health industry has more opportunities than ever to partner with it and NHS England to help improve access to innovative therapies for patients.

The NICE Conference 2025 also delivered clear messages that more focus is needed on implementation and service provision to ensure patients are actually able to access approved innovative medicines. Conference speakers encouraged manufacturers to engage with NICE and NHS England to look for opportunities to test the potential for medtech firms to support improvements in implementation/service provision for new medicines.

AI and the future of healthcare

The NICE Conference 2025 explored how AI can be used in clinical settings and to generate real-world data. The conference also agreed that a UK national strategy and system of using AI is needed. The key message here was that AI technologies should be evaluated just as all other technologies are but a system needs to be put in place to manage this.

The conference discussed how AI can support the NHS and speed up the delivery of best care to patients. Questions were also raised as to whether AI will help or hinder efforts to reduce health inequalities. A key question posed at the conference was: What would AI-reliant service delivery look like?

AI is already being used in multiple ways within the health and social care system. Examples include:

• Use of AI to span preclinical/clinical trials/diagnostics/non-clinical use. AI is used to streamline drug response data (e.g. pharmacokinetics) in early phase trials
• Trial design and patient recruitment
• Drug repurposing, using a drug for a better purpose – machine learning, scanning potential targets in a different indication. This is particularly useful in gene therapies
• Evidence synthesis and systematic literature reviews use AI for scanning the search strategy, abstracts, extracting data etc. The result has seen a 95% reduction in staff and a 50% reduction in time spent on such tasks
• AI could also be used to draft submissions to regulators and for HTA submissions. This initiative has been piloted on a regulatory submission
• Companies are starting to use AI to create models/meta analyses, but they need to be transparent when this is happening. In terms of transparency, the NICE position statement on using AI in evidence generation and reporting, published in August 2024, is a starting point and other HTA bodies have licensed it

In clinical practice the following are being trialed:

• Radiology using AI
• AI use in breast screening and fractures
• Using AI within the first histopathology lab
• Looking at opportunities to reduce the burden on clinical and non-clinical teams (for example, AI is used to print out badges but also to sift through databases).

Methods and processes must keep pace with change

In 2022, NICE published its revised NICE Health Technology Assessment Evaluations: the Manual. The guidance set out the methods and processes NICE follows when evaluating health technologies and included some positive changes, such as the introduction of a severity modifier and flexibility to accept greater uncertainty in some circumstances, including for medicines to treat rare diseases. In practice NICE said the severity modifier, which is a method giving more weight to treatments that treat severe diseases, is operating as intended, since it is being used across a broad range of indications. One example given at the conference was its use in health technology assessments of cystic fibrosis and childhood epilepsy. However, there were questions about how well the current severity modifiers reflect societal preferences in relation to disease severity; so although the modifiers are being used across indications, they may not always accurately reflect the impact of the disease. NICE tries to accommodate this by allowing for a degree of flexibility in the application of the modifier, and by taking into account clinical opinion and patient input, particularly where data may be limited. But there was acknowledgment that there may still be work to be done.

Real-world evidence

In terms of real-world evidence, the manual also approved consideration of more than randomized controlled trial data as evidence sources. Consultation on the manual was so extensive and time consuming that going forward it will be revised on a modular basis instead of a full revision once every 10 years. The modular approach is intended to enable NICE to review sections of the manual based on what matters most at a particular point in time. The overall aim is that NICE’s methods and processes should be fit for purpose to consider the latest scientific advances being made within the life sciences industry. NICE will also be quicker and more flexible at responding to advances with updates to its guidance.

Innovative pharmaceuticals and health technologies are constantly challenging health economists, statisticians, researchers and others working in multidisciplinary teams to think in new ways about the methods and processes they use to provide comprehensive assessments of the health technologies being submitted to NICE. The NICE Conference 2025 considered the latest work NICE is doing to ensure its methods and processes remain fully transparent, reflect societal preferences and accommodate innovation. 

 Among other key issues discussed were:

• Confidentiality marking: NICE no longer accepts academic in confidence (AIC) marking, but it is now seeing more data redacted than ever before as companies do not want to share all their information at Appraisal Committee meetings. NICE is aiming to work with companies to create a balance and to avoid unintended consequences of its methods updates in the future
• Open-source modeling, where technical aspects of a model are made publicly available
• NICE needs to consider the limits regarding societal preferences
• The NICE effectiveness threshold generally considers interventions costing between £20,000 and £30,000 per quality-adjusted life year (QALY) gained as representing good value for money for the NHS. There is a push from stakeholders to formalize the threshold. NICE is however resistant to take this forward as the more formalized the thresholds get, the less able they are to accommodate innovation

Conclusion

The NICE Conference 2025 brought together frontline staff, leaders from health and social care, the life sciences, medtech and digital sectors. Everyone was looking back at what NICE has achieved to date. We were also exploring how NICE is transforming itself to stay a step ahead of scientific advances within the life sciences industry and their possible impact on the NHS. In the past 25 years NICE has doubled the number of technology appraisals completed in under 10 years – having completed 500 in 18 years and reaching 1,000 in September 2024. What we heard was confirmation that NICE is evolving with new industry partnerships that could enable it to outshine its first 25 years.