A safe space for bold ideas – implementing a sandbox approach in health technology assessment

In today's rapidly evolving healthcare landscape, health technology assessment (HTA) agencies face a difficult challenge: keeping up with the fast-paced development of innovative technologies. Traditional assessment methods sometimes struggle to evaluate new treatments. HTA agencies must continue to evolve to avoid potentially delaying patient access to life-changing innovations.

The sandbox solution

The sandbox concept, originally developed in the financial technology sector, creates a safe and controlled environment where new ideas, products, or processes can be explored and developed without impacting existing systems or users. In the context of HTA, a sandbox allows agencies to experiment with innovative assessment methods and collaborate with stakeholders, isolated from the pressures of live evaluations.

As part of the EU-funded Next Generation Health Technology Assessment (HTx) project, we conducted a literature review to explore the extent of sandbox use in healthcare and assessed its potential for HTA organisations. We followed this up by testing the sandbox approach to address some known HTA challenges. Finally, we developed a series of recommendations to help HTA agencies implement this innovative testing ground.

Key findings

Through our literature review, The sandbox approach and its potential for use in health technology assessment, we found that:

• regulatory sandboxes in healthcare are relatively new and primarily used in high-income countries

• they mainly support the adoption of new technologies, particularly in digital health

• despite its potential, this approach was not being used in HTA.

We concluded that HTA agencies should consider this approach to facilitate developing policies, methods and processes for innovative and disruptive health technologies.

Recommendations for implementation

Our paper, Implementing a sandbox approach in health technology assessment: benefits and recommendations, provides guidance on effective implementation.

Key recommendations for HTA agencies include:

• use sandboxes in an anticipatory way: align with horizon-scanning efforts to prepare for upcoming challenges

• focus on technical solutions: HTA sandboxes are most useful for challenges expected to have objective technical solutions (rather than challenges relating to values or ethics, for example)

• communicate clearly: define the sandbox scope, objectives and safe space concept to manage stakeholder expectations and mitigate potential conflicts.

Applying the concept

This work has laid the foundations for NICE's own sandbox - our HTA Innovation Laboratory. The HTA Lab presents an exciting opportunity for NICE, and our stakeholder community. Through a process of co-creation, it is helping us develop solutions to complex HTA issues. We’ve already used it in the development of:

• a new approach to appraising medicines which are highly likely to need a managed access agreement

• our guidance on virtual ward platform technologies for people with acute respiratory infections.

Current HTA Lab projects include:

• AI in HTA

• comparing environmental impacts of health technologies

• emerging treatments for metabolic dysfunction-associated steatohepatitis.

Shaping the future

Sandboxes can play an important role in shaping the future of HTA. As healthcare rapidly evolves, particularly in areas like AI and personalised medicine, the flexibility and innovation fostered by sandboxes will be crucial in ensuring organisations like NICE have HTA methods that keep pace with technological advancements. By embracing this concept, HTA agencies can position themselves at the forefront of healthcare innovation, driving improvements in patient care.

Find out more

NICE participates in various methodological research projects with partners around the world, such as HTx. These partnerships help us improve our work. They also help us anticipate and adapt to policy developments, including changes in health and social care delivery.

You can learn more about one of our other key outputs from the HTx project in our blog post: Introducing CHEERS-AI: improving health economic evaluation reporting for AI technologies.

If you'd like to learn more about our ongoing research projects or discuss potential collaborations, please reach out to our research team. Contact us today to explore how we can work together to advance healthcare methodological research.