We supported our client in reversing a negative decision in one of the longest-running technology appraisals in NICE’s history. The programme involved careful scrutiny of appraisal processes and building stakeholder advocacy for the incorporation of real-world evidence into the technology appraisal.  The result was a changed approach from the appraisal committee that enabled thousands of patients with liver failure to receive treatment which delays the recurrence of severe neurological symptoms, preventing emergency admissions to hospital and reducing length of stay.