Moving Towards Evidence Based Reimbursement of Health Tech: Thoughts for Innovators
Over the past year, we’ve seen growing momentum in the UK toward a more structured and predictable pathway for evaluating, funding, and adopting medical technologies within the NHS.
Historically, a persistent imbalance has existed between how medicines and medical technologies are handled in terms of national assessment and reimbursement. While medicines benefit from established, centralised pathways, MedTech has often relied on fragmented, localised decision-making. This has created barriers to adoption — especially for early-stage companies trying to navigate a system that isn’t designed with their innovation cycles in mind.
That’s beginning to shift.
A series of initiatives — from early value assessments to more formalised late-stage evaluations — have started to lay the groundwork for a new approach. These developments point towards a more integrated lifecycle model for MedTech: one that links innovation, evidence generation, cost-effectiveness, and funding decisions into a more coherent whole.
What’s emerging is a two-part model:
First, a clearer set of principles underpinning how national bodies evaluate technologies — including expected methods for assessing clinical and cost-effectiveness, the importance of maintaining independence in review, and a growing recognition of the need to transform care pathways and address systemic inequalities.
Second, an intent to support commissioning and uptake of products that demonstrate value. This includes potential access to centrally managed funds, alignment with NHS priorities, and tools to help local commissioners (ICBs, trusts, neighbourhood services) make more confident adoption decisions — even in the absence of statutory reimbursement.
Importantly, while value is still largely defined in cost-effectiveness terms (with indicative thresholds around £20,000 per QALY and capped annual budget impact), there are signs that broader factors — such as productivity, patient empowerment, and health system sustainability — are gaining traction in decision-making.
The ambitions are sensible and welcome. But they’re not without limitations.
Assessment capacity remains constrained, and there’s no current commitment to introduce statutory reimbursement for MedTech in the way that exists for medicines. National adoption will remain the exception, not the rule — at least in the near term.
There’s also a notable gap around technologies that demonstrably save the NHS money but do not fall within narrow HTA thresholds. Many such innovations still struggle to find traction because upfront funding isn’t available, even when longer-term savings are clear. In our view, a mechanism for reimbursing cost-saving MedTech — especially where those savings are backed by robust evidence — is long overdue.
Environmental sustainability is another blind spot. Given the NHS’s ambitious net zero targets, it’s surprising that greener MedTech alternatives have yet to feature more prominently in value assessments.
Even so, the overall direction is positive. The NHS appears to be moving toward a more consistent and transparent model for evaluating and scaling beneficial technologies. The challenge now is execution — and ensuring that startups, in particular, have the right support to navigate this emerging landscape.
Companies therefore need to be aligning their evidence and commercial strategies with this new reality. That includes early-stage planning to meet evolving evaluation standards, support for engaging local and national decision-makers, and positioning for upcoming opportunities as national routes mature.
If you’re developing a device, diagnostic, or digital platform with clear clinical and economic value, now is the time to start thinking about where and how that value will be recognised — and what kind of evidence, pricing, and partnership strategies will support your route to scale.