For decades, the National Health Service has, for the most part, purchased medical technology using the same criterion it uses to buy paperclips: price. So, a cheap device that was associated with increased complications, longer lengths of stay or more frequent recurrences could be favoured over a more costly one that delivered better health outcomes across the whole patient pathway. Everyone knew this was wrong, but the practice nonetheless persisted.
On 11 June, all this changed. The Department of Health and Social Care’s new Value-based procurement national standard guidance for medical technology sets a single rule that inverts the old order. NHS buyers across both primary and secondary care that are specifying their medical device requirements or evaluating tender submissions may now allocate, at most, only 40% of their scoring criteria to a device’s whole life cost. At least 60% must be distributed across five “value domains” of which at least 10% must be reserved for the social value domain. In a market worth roughly £10 billion a year, a medical device’s sticker price has now become much less important than the value it delivers.
For NHS suppliers and buyers alike, two critical questions now come to the fore: how is value defined and how is it evidenced?
Evidencing value with HEOR
It is tempting to believe that this national standard – first published in draft form in October 2025 and piloted in live procurements across 13 NHS Trusts – is merely tweaking how the scoring of tenders is weighted. But the new standard goes considerably further by defining value across the five domains of social value, efficiency, patient and staff, supply chain and purpose and inviting buyers to evaluate medical devices using questions chosen from within the most relevant domains using an approach that is proportionate to the cost, nature and complexity of the procurement.
There are a total of twenty-one possible questions, many of which can only be answered using evidence generated by health economics and outcomes research (HEOR). As the heat map below shows, evidencing value in two domains – efficiency and patient and staff – and evaluating whole life cost, is highly dependent on this discipline.
- Domain 2: Efficiency – asks suppliers to model current patient pathways to identify and quantify bottlenecks; to provide real-world data demonstrating a device’s impact on lengths of stay, readmissions and day-case conversions; to model productivity against baseline weighted activity units and – perhaps most crucially – to measure and monitor the delivery of each claimed efficiency benefit using NHS Hospital Episode Statistics or other clinically coded data.
- Domain 3: Patient and staff – requires evidence of how a device enhances the process of care for the patient, their carers and family; of how it reduces the incidence of complications such as surgical site infections; improves patient-reported outcomes; delivers additional quality-adjusted life years and reduces disease burden. A dedicated question on health inequalities provides scope to import fast-maturing methods of equity-informative health economic evaluation.
- Whole Life Cost – must be evidenced using a cost model that calculates the total cost of a device over its expected lifetime.
None of this is procurement language with a clinical veneer. It is HEOR evidence that must be imported directly into a tender response. For medtech companies, excellence in HEOR has always been important in achieving market access. Now it is critical.
The changing role of HEOR in medtech
The new standard has further implications for HEOR with regard to both the point in the product lifecycle at which evidence must be generated and the purpose that evidence must serve. In the medtech sector, health economic evidence has conventionally been produced after market entry to facilitate reimbursement, market access and value communication. However, value-based procurement is now relocating HEOR activity in two directions simultaneously. It is brining some activities upstream, to the pre-award stage, since proof of value is now required at the point of tender submission. It is also shifting it downstream, beyond the point of award, where data will be collected to test whether the device delivers the value that was claimed for it.
The shift in timing also brings a change of purpose. Evidence that was once generated to persuade a payer will now be generated to win a scored contract and for comparison with real-world data demonstrating the value a device is actually delivering in service. This evidence will have to exist before a sale is made and remain defensible long afterwards. So, for medtech companies, HEOR is no longer a post-launch activity that supports market access. It is now a tender-critical capability that determines who wins the contract and whether the value promised in the bid can be delivered in practice.
A decisive role
The elevation of value-based procurement to a national standard, without methodological amendment following its pilot phase, establishes a settled basis on which medical technology will be evaluated by NHS buyers for the foreseeable future. The new standard does, of course, include questions – on modern slavery, the circular economy and interoperability – on which health economics and outcomes research has little to say at present. But the standard elevates the importance of timely, methodologically robust evidence in two ways: by allocating the majority of a tender’s score to questions that medtech suppliers are likely to be least equipped to answer without specialist input, and by holding them accountable for the value claims they make during the bidding process.
Future posts in this series will take a deeper dive into each of the value-based procurement domains where health economics and outcomes evidence will play a critical role under the new standard. Beginning with the efficiency domain, we will distinguish a low scoring tender response from one in which the quality of HEOR evidence makes it outstanding.
