These are the main stages in the multiple technology appraisal process used before April 2018.

It applies to evaluations that started before 1 February 2022. 

In April 2018, following the publication of our new methods, processes and topic selection manualswe implemented a new MTA process. The new manuals apply to evaluations that began after this date.

View the new processView the timeline for single technology appraisals

Timings are approximate. For a full description of the appraisal process, please see our process guide and methods guide.

Topics are referred to us by Ministers following the topic selection process.


  • wk0

    Development starts

    We invite relevant stakeholders (known as consultees and commentators) to take part in the appraisal and to nominate clinical, commissioning and patient experts

    We ask consultees to submit any relevant information about the topic.

    They have 14 weeks to send in their submissions.

    Find out more about consultee submissions

    Organisations can apply to become a consultee or commentator at any point in the process. 

  • wk0

    Key information added to our website

    We add the remit, scope and a list of consultees and commentators to the website.  

    The remit is the brief for the appraisal. The scope sets out what the technology appraisal will cover and the questions that need to be addressed.

  • wk8

    Stakeholder information meeting (SIM) may be held

    All consultees and commentators can send up to 2 representatives to the meeting.

  • wk14

    Deadline for the receipt of consultee submissions

  • wk15

    Evidence review begins

    We send the consultee submissions to an independent academic centre (called the Assessment Group).

    They use the consultee submissions to help write the assessment report on the clinical and cost-effectiveness of the technology(ies).

  • wk16

    Expert invitations

    We invite the selected clinical, commissioning and patient experts to attend the appraisal committee. We ask them to submit a statement on the technology and how it should be used in the NHS in England.

  • wk28

    Assessment Group report received by NICE

  • wk30

    Assessment report sent to the consultees and commentators for comment

  • wk31

    Assessment report published on our website for information

  • wk32

    Deadline for receipt of the expert statements

  • wk34

    Deadline for the consultee and commentator comments on the assessment report

  • wk36

    Key documents sent to the appraisal committee

    The appraisal committee is an independent advisory committee that makes recommendations.

    We send attendees:

    • the assessment report and any comments
    • the AG's response to comments on the assessment report
    • submissions from the professional, patient/carer and NHS commissioning consultees
    • summaries of the company submissions (full submissions are available to the Committee)
    • a pre-meeting briefing written by NICE's technical lead for the appraisal.

    We don’t send the papers to any members of the public who have registered to attend the meeting. 

  • wk37

    Appraisal committee meets to consider the evidence

    We hold an appraisal committee meeting to consider the committee papers and hear from nominated clinical, patient and NHS commissioning experts.

    The committee will decide to develop an appraisal consultation document (ACD) or final appraisal document (FAD).

    The ACD contains the draft recommendations from the Appraisal Committee. The FAD is the final draft of the guidance and includes the committee's final recommendations.

    We produce an ACD when the recommendations from the Appraisal Committee don’t recommend use of the technology, or limit the use of the technology beyond the specifications in the marketing authorisation.

    If an ACD isn’t needed we move straight to developing the final appraisal document (FAD) (see week 42).

    Part 1 of this meeting is open to members of the public and press.

    Register to attend a meeting

  • wk40

    Appraisal consultation document (ACD) and supporting documents sent out for comment

    Consultees and commentators have 20 working days to submit their comments on the draft recommendations.

  • wk41

    Public consultation on the ACD 

    The ACD and supporting documents are published on the website for comment. The consultation is open for 15 working days.

    Anyone can submit comments during consultation.

    View open consultations

  • wk42

    Final appraisal document (FAD) sent to consultees and commentators for comment (if no ACD produced)

    Consultees have 15 days to appeal.

    Find out more about the appeals process

  • wk44

    Public consultation on the ACD ends

  • wk45

    Appraisal committee meet to develop the FAD

    The Appraisal Committee considers the comments received on the ACD, then makes its final recommendations on how the technology should be used in the NHS in England. This is the FAD.

    Find out more about the appeals process

    Part 1 of the meeting is open to members of the public and press.

    Register to attend a meeting

  • wk47

    Guidance issued (if no ACD)

    If no ACD was produced and no appeals have been received, the topic is published.

    This is the earliest possible point that final guidance can be issued.

  • wk51

    FAD and supporting documents sent to consultees and commentators

    Consultees have 15 days to appeal against the final recommendations in the FAD.

    Find out more about the appeals process

  • wk52

    FAD published

    We publish the FAD and supporting documents on the website for information.

  • wk54

    Close of appeal period

    If no appeals have been received, the guidance is prepared for publication. If appeals have been received, the appeals process is followed.

  • wk60

    Technology appraisal publishes

    If there are no appeals the final recommendations are issued as NICE guidance.

    The technology appraisal is published on the NICE website. Registered stakeholders are notified by email.

    When the guidance is published we give a date for it to be reviewed. This is when we consult with relevant organisations about whether the guidance needs to be updated.

    Find out more about the review process