A 10-Year Review of the Willingness-to-Pay (WTP) Thresholds for Single Technology Appraisals From the National Institute for Health and Care Excellence (NICE)

OBJECTIVES: NICE state net health benefits should be presented using values placed on a QALY-gain of £20,000-£30,000, with decisions on values above £20,000 made at NICE’s discretion. This research aims to provide insight into circumstances where NICE may apply a more stringent £20,000 threshold or give flexibility to accept ICERs up to and above £30,000.

METHODS: A literature review was conducted to identify NICE appraisals over the 10-years between May 2014 and April 2024 to understand key considerations and themes in how NICE determine the appropriate WTP threshold.

RESULTS: The review identified 665 unique Single Technology Appraisals. Once terminated, withdrawn and duplicate appraisals (with superseded guidance) were removed a final sample of n=482 remained.

In 47 instances (9.8%), NICE guidance explicitly indicated recommendations would be made considering a WTP threshold at the lower end of the range (£20,000). In 44 instances (9.1%) NICE directly stated a willingness to accept ICERs at the upper end of the range (£30,000) and in several cases made positive recommendations based on plausible ICERs above £30,000 (despite not qualifying for a relevant severity modifier or the previous end of life criteria). The most common reasons for this were the presence of uncaptured benefits not reflected in the standard reference case, when QALY gains were expected to be underestimated or where wider system-level cost savings were anticipated. Of the n=44 appraisals where the upper end of the threshold was considered relevant, the majority (59.1%) were appraised since 2021, compared with 40.1% in the years 2014-2021 suggesting that in recent years, there has been an increased willingness to transparently accept technologies that may offer wider benefits.

CONCLUSIONS: Manufacturers who expect to submit to NICE with ICERs above £20,000 may see value in exploring whether their technology is associated with the wider uncaptured benefits which lay outside of the NICE reference case.