Evidence hierarchy in GVDs: the use of non-randomised evidence following NICE’s recent methods update

Apr 4, 2022

Written by Pip White, Senior Medical Writer

The global value dossier (GVD) is a vital resource to ensure internal strategy alignment and facilitate external communication. As described in our previous blog, GVDs incorporate evidence-based messaging, comprehensive trial results, and robust economic analyses to convey the product value story. 

Randomised controlled trials (RCTs) have traditionally been considered the gold standard for evaluating the efficacy and safety of an experimental intervention. This is mainly due to RCTs following prospective study protocols in which endpoints are pre-defined and eligible study participants are randomly assigned to treatment groups. Whilst RCTs continue to provide the highest level of evidence, the need for real-world evidence and data collection when RCTs are deemed unethical/impractical necessitate non-randomised interventional and observational studies. 

In the National Institute for Health and Care Excellence’s (NICE) recent methods update, RCTs remain at the top of the evidence hierarchy; however, NICE acknowledge the potential disadvantages of RCTs and the strengths of non-randomised studies. The greater recognition of non-randomised evidence is new to the update and may reflect a movement towards an evidence base in which RCTs and non-randomised studies provide complementary evidence if appropriately justified.  

NICE processes and assessments are held in high esteem and its methods underpin many health technology assessment (HTA) processes across Europe. Given NICE’s far-reaching influence, it is likely that other countries will follow suit with respect to their recognition of non-randomised evidence. This step-wise development at an HTA-level may subsequently impact the choice of evidence presented in GVDs. Specifically, this may lead to non-randomised studies being increasingly included when RCT data are absent/limited. The inclusion of supplementary non-randomised studies may also provide long-term evidence in a wider patient population that is reflective of clinical practice. 

If you would like to learn more about evidence selection when communicating the value of your product, please contact the Market Access and Value Communication team at Source Health Economics. 


More Insights

HTA monthly update

HTA monthly update

By Toby Hobbs   Changes to NICE ICER thresholds confirmed NICE has announced that from April 2026 there will be an increase to its cost-effectiveness threshold. This marks one of the biggest shifts in UK Health technology assessment ... Read more

Evaluating Health Inequalities: NICE’s Modular Update

Evaluating Health Inequalities: NICE’s Modular Update

Written by Paloma Charlesworth (Assistant Project Manager)   Background  Health inequalities are systematic, avoidable, and unjust differences in health outcomes between patient groups. Despite decades of policy and research, they not ... Read more

HTA monthly – October 2025

HTA monthly – October 2025

By Kiera Lander   October brought real movement across the health technology assessment (HTA) landscape — not just in HealthTech, but across medicines, strategy, and international collaboration. From National Institute for Health and ... Read more

RAISE guidance – maintaining SLR standards in an AI-assisted future

RAISE guidance – maintaining SLR standards in an AI-assisted future

Written by Gwennie Ogilby (Associate Systematic Review Analyst) and Tom Metcalf (Senior Systematic Review Analyst)   Systematic literature reviews (SLRs) are considered one of the strongest forms of evidence to guide healthcare ... Read more