How End of Life Translates to Severity Weighting Under the New National Institute for Health and Care Excellence (NICE) Methodology. A Review of Past Oncology Appraisals

OBJECTIVES: In February 2022, NICE updated its methods for Health Technology Appraisal; a quality-adjusted life-year (QALY) weighting, the severity modifier, was introduced to place greater value on treatments for severe diseases, effectively changing the willingness-to-pay threshold. ‘Severity’ is quantified by the absolute and proportional QALY shortfall on current standard-of-care relative to the general population. This methodology replaced the end-of-life (EOL) criteria (and corresponding £50,000/QALY threshold). This research evaluates previous NICE oncology appraisals to determine the QALY weighting and corresponding threshold which would have applied under the new framework.

METHODS: NICE single technology oncology appraisals were identified between 1st January 2020 to 1^st April 2023 conducted under the previous NICE methods with sufficient publicly available information to reliably estimate the proportional and absolute QALY shortfall.

RESULTS: The review identified 153 oncology appraisals, of which, 122 were appraised under the previous NICE methods. Of the 122, 34 had sufficient information to calculate the proportional and absolute shortfall. Of the 34 appraisals, 20 (59%) met the previous EOL criteria. Of these 20, three (9%) would meet the 1.7x QALY weighting and 15 (75%) would meet the 1.2x QALY weighting under the new methods. Fourteen did not meet the previous EOL criteria, of these, none would be considered under a 1.7x QALY weighting, and five (36%) would be relevant for a 1.2x QALY weighting.

CONCLUSIONS: Although this analysis is limited by the number of appraisals with publicly available information, results suggest that the majority of previous EOL treatments would meet the criteria for a severity modifier weighting under the new framework, however most would not meet the criteria for the higher 1.7x weight commensurate to the previous EOL criteria. This new approach may result in lowering the effective willingness-to-pay for many end-of-life medicines, which could impact patient access to innovative oncology treatments in England.