Table 2.

A summary of NICE medical technologies guidance (MTG) relating to the heart or circulation

MTG	Date of publication	Clinical recommendations	Cost consequences
MTG1: SeQuent Please balloon catheter for in-stent coronary restenosis	December 2010	1.1 The case for adopting SeQuent Please balloon catheter in the NHS, when used as described in 1.2 and 1.3, is supported by the evidence. The need for subsequent reintervention for coronary stenosis is reduced as is the duration of clopidogrel therapy, compared with paclitaxel-eluting stent… 1.2 SeQuent Please balloon catheter should be considered for use in patients with in-stent restenosis in bare metal coronary artery stents. 1.3 SeQuent Please balloon catheter can also be considered as an option for patients with in-stent restenosis in any type of coronary artery stent if: There are clinical reasons to minimise the duration of clopidogrel treatment (eg, there is concern about an increased risk of bleeding or there is the need for surgical intervention) or Placement of further stents is not technically possible.	1.1 …SeQuent Please balloon catheter is associated with a cost saving of £467 per patient compared with paclitaxel-eluting stent.
MTG3: CardioQ-ODM oesophageal Doppler monitor	March 2011	1.1 The case for adopting the CardioQ-ODM in the NHS, when used as described in 1.2, is supported by the evidence. There is a reduction in postoperative complications, use of central venous catheters and in-hospital stay (with no increase in the rate of readmission or repeat surgery) compared with conventional clinical assessment with or without invasive cardiovascular monitoring… 1.2 The CardioQ-ODM should be considered for use in patients undergoing major or high-risk surgery or other surgical patients in whom a clinician would consider using invasive cardiovascular monitoring.	1.1 …The cost saving per patient, when the CardioQ-ODM is used instead of a central venous catheter in the perioperative period, is about £1100 based on a 7.5-day hospital stay.
MTG8: The VeriQ system for assessing graft flow during coronary artery bypass graft surgery	November 2011	1.1 The case for adopting the VeriQ system in the NHS for assessing graft flow during coronary artery bypass graft (CABG) surgery is supported by the evidence. The evidence suggests that intraoperative transit time flow measurement is effective in detecting imperfections that may be corrected by graft revision. This may reduce the incidence of graft occlusion and may reduce perioperative morbidity and mortality.	1.2 The VeriQ system is associated with an estimated cost saving of £115 per patient compared with clinical assessment, when it is used routinely for assessing CABGs during surgery.
MTG13: WatchBP Home A for opportunistically detecting atrial fibrillation during diagnosis and monitoring of hypertension	January 2013	1.1 The case for adopting WatchBP Home A in the NHS, for opportunistically detecting asymptomatic atrial fibrillation during the measurement of blood pressure by primary care professionals, is supported by the evidence. The available evidence suggests that the device reliably detects atrial fibrillation and may increase the rate of detection when used in primary care. This would allow prophylactic treatment to be given to reduce the incidence of atrial fibrillation-related stroke. WatchBP Home A should be considered for use in people with suspected hypertension and those being screened or monitored for hypertension in primary care. 1.2 People suspected of having atrial fibrillation after use of WatchBP Home A should have an ECG in line with NICE clinical guideline 36, atrial fibrillation.	1.3 Use of WatchBP Home A in primary care is associated with estimated overall cost savings per person measured, ranging from £2.98 for those aged between 65 years and 74 years to £4.26 for those aged 75 years and over. There is uncertainty about the costs and benefits for people younger than 65 years; however, it is plausible that using the device in this group will benefit patients and the healthcare system. Cost analyses did not support the use of the device by patients in their homes.
MTG16: The E-vita open plus for treating complex aneurysms and dissections of the thoracic aorta	December 2013	1.1 The case for adopting the E-vita open plus for treating complex aneurysms and dissections of the thoracic aorta, in a carefully selected group of people, is supported by the evidence. 1.2 Using the E-vita open plus could remove the need for a second procedure and the associated risk of serious complications, and it should therefore be considered for people: Who would otherwise need a two-stage repair procedure because their aortic disease extends into or beyond the distal part of their aortic arch (into the proximal descending aorta), but Who would not need additional intervention (such as stent grafting) in the descending aorta.	1.3 The E-vita open plus is estimated to generate cost savings compared with current two-stage repair from about 2 years after the procedure. The estimated cost saving per patient at 5 years after the procedure is around £13 800 when compared with two-stage repair involving open insertion of a vascular graft, £9850 when compared with two-stage repair involving endovascular stent grafting and £12 000 when compared with open surgical debranching followed by endoluminal stent grafting. At 10 years after the procedure, the estimated cost savings range from around £21 850 to £28 160 across the three comparators.
MTG32: HeartFlow FFRCT for estimating fractional flow reserve from coronary CT angiography	February 2017	1.1 The case for adopting HeartFlow FFRCT for estimating fractional flow reserve from coronary CT angiography (CCTA) is supported by the evidence. The technology is non-invasive and safe and has a high level of diagnostic accuracy. 1.2 HeartFlow FFRCT should be considered as an option for patients with stable, recent onset chest pain who are offered CCTA as part of the NICE pathway on chest pain. Using HeartFlow FFRCT may avoid the need for invasive coronary angiography and revascularisation. For correct use, HeartFlow FFRCT requires access to 64-slice (or above) CCTA facilities.	1.3 Based on the current evidence and assuming there is access to appropriate CCTA facilities, using HeartFlow FFRCT may lead to cost savings of £214 per patient. By adopting this technology, the NHS in England may save a minimum of £9.1 million by 2022 through avoiding invasive investigation and treatment.
MTG33: ENDURALIFE-powered cardiac resynchronisation therapy-defibrillator (CRT-D) devices for treating heart failure	March 2017	1.1 The case for adopting ENDURALIFE-powered CRT-D devices for treating heart failure is supported by the published evidence. Extended battery life is of clinical and patient benefit and associated with fewer replacement procedures. 1.2 ENDURALIFE-powered CRT-Ds should be considered as an option in people offered CRT-D devices in line with NICE Technology Appraisal Guidance on implantable cardioverter defibrillators and cardiac resynchronisation therapy.	1.3 Cost modelling was based on published data using predecessor devices and showed that the price and lifespan of the CRT-D have the greatest effect on overall treatment costs. Assuming an average selling price of £12 404 across different devices, using ENDURALIFE-powered CRT-Ds may save between £2120 and £5627 per patient over 15 years through a reduction in the need for replacement procedures. This could save the NHS in England around £6 million in the first 5 years.

NHS, National Health Service; NICE, National Institute for Health and Care Excellence.