The gekoTM device is a single-use, battery- powered, neuromuscular electrostimulation device that aims to reduce the risk of venous thromboembolism (VTE). The National Institute for Health and Care Excellence (NICE) selected the gekoTM device for eval- uation, and invited the manufacturer, Firstkind Ltd, to submit clinical and economic evidence. King’s Technol- ogy Evaluation Centre, an External Assessment Centre (EAC) commissioned by the NICE, independently asses- sed the evidence submitted. The sponsor submitted evi- dence related to the gekoTM device and, in addition, included studies of other related devices as further clinical evidence to support a link between increased blood flow and VTE prophylaxis. The EAC assessed this evidence, conducted its own systematic review and concluded that there is currently limited direct evidence that gekoTM prevents VTE. The sponsor’s cost model is based on the assumption that patients with an underlying VTE risk and subsequently treated with gekoTM will experience a reduction in their baseline risk. The EAC assessed this cost model but questioned the validity of some model assumptions. Using the EACs revised cost model, the cost savings for gekoTM prophylaxis against a ‘no prophylaxis’ strategy were estimated as £197 per patient. Following a second public consultation, taking into account a change in the original draft recommendations, the NICE medical technologies guidance MTG19 was issued in June 2014. This recommended the adoption of the gekoTM for use in people with a high risk of VTE and when other mechanical/pharmacological methods of prophylaxis are impractical or contraindicated in selected patients within the National Health Service in England.