Presentation (CTI)

OBJECTIVES: In January 2022, NICE introduced the severity modifier method, which adjusts Quality Adjusted Life-Years (QALYs) to reflect disease severity. This modifier is based on the absolute and proportional QALY shortfall (AS and PS) of the current standard-of-care (SoC) compared to the general population of the same age and sex. Depending on the magnitude of these shortfalls, a modifier of 1.2x or 1.7x is applied to the incremental QALY gain. The objective of this study is to review the impact of severity modifiers on the willingness to pay, drawing insights from previous technology appraisals before introduction of severity modifiers.
METHODS: Single technology appraisals (STAs) that met our eligibility criteria and were published before January 2022 were identified (N = 2). The data needed to estimate the AS and PS were gathered from committee papers and NICE guidance. The QALY Shortfall Calculator tool was used to estimate the AS and PS weights.
RESULTS: Among the two identified appraisals, one appraisal was recommended with WTP thresholds above £50,000 per QALY, meeting end of life criteria (EOL), and the other one has a threshold below £20,000 per QALY not meeting EOL criteria. Applying QALY shortfall severity weights on both appraisals, the thresholds decrease from £50,000 to £36,000 for the first appraisal whereas increased from £20,000 to £36,000 for the other. Both appraisals received a severity weight of 1.2x, resulting in AS and PS values of 11.43% and 92.6%, 14.8% and 85.2%.
CONCLUSIONS: The NICE severity modifier, while an improvement over previous End-of-Life (EOL) criteria, may alter WTP thresholds for existing technologies, potentially impacting pricing decisions. While highly relevant in oncology, the impact of the severity modifier on WTP thresholds may vary across different indications.