Promoting innovation while controlling cost: The UK's approach to health technology assessment

•New health technologies can improve treatment options but also increase costs.•The UK has developed robust and transparent health technology assessment processes.•There are important limitations to the cost per QALY and threshold approach.•Health technology assessment in England and Scotland differs in several ways.•The UK faces emerging challenges and opportunities related to health technology assessment. New technologies, including pharmaceuticals and medical devices, can improve treatment options in healthcare but also bring concerns about rising healthcare costs. We undertake a narrative review of the United Kingdom's (UK) approach to appraising new health technologies. We find that the National Institute for Health and Care Excellence (NICE), Scottish Medicines Consortium (SMC) and All Wales Medicines Strategy Group (AWMSG) have contributed to the UK's robust and transparent approach towards the evaluation of new health technologies using the cost per QALY approach. However, there are limitations to this approach including several external benefits not captured, bias against less treatable diseases, and deciding the appropriate level of the threshold. NICE, SMC, and AWMSG have attempted to overcome some of these limitations by considering additional factors such as end-of-life criteria, highly specialised treatments, and populations that experience unmet need. Looking to the future, the advent of ‘personalised’ and ‘genomic’ medicine, will likely mean the UK has to accommodate an increasing number of ‘step-change’ and ‘highly specialised’ technologies as well as respond to changes in pharmaceutical licensing and increasing use of real-world evidence.