EVOLVING COST-EFFECTIVENESS THRESHOLDS AT NICE: CHANGES IN THE BASE THRESHOLD AND USE OF HIGHER THRESHOLDS IN SPECIAL CASES
Author(s)
Ali Shajarizadeh, PhD, Nishu Gaind, MBA, Luka Ivkovic, MSc, Gopika Balasubramanian, MSc, Mir Sohail Fazeli, PhD, MD;
Evidinno Outcomes Research Inc., Vancouver, BC, Canada
Evidinno Outcomes Research Inc., Vancouver, BC, Canada
OBJECTIVES: The base cost-effectiveness threshold of £20,000-£30,000 per QALY by NICE has remained nominally unchanged until recently (new threshold will apply from April 2026), despite substantial inflation and growth in National Health Service expenditure. Over time, this implies a decline in the inflation-adjusted value of the willingness-to-pay (WTP) per QALY for most technologies. In parallel, policy developments including the severity modifier introduced in 2022 and the Highly Specialized Technologies (HST) programme for ultra-rare diseases allow substantially higher effective thresholds in selected contexts. We aimed to quantify (a) the real-terms erosion of NICE’s base threshold over time, and (b) the extent of the divergence between effective threshold “tiers” across standard single technology appraisals (STAs), severity-modified appraisals, and HST evaluations in the UK from 2015-2025.
METHODS: We reviewed published NICE STA and HST guidance and committee papers (2015-2025) to extract reported or committee-preferred ICERs, appraisal route and application of modifiers (end-of-life, severity, HST). The £20,000-£30,000 range was inflation-adjusted using UK price indices. Accepted ICER ranges were summarized descriptively by appraisal context and disease area.
RESULTS: Inflation-adjustment suggests a substantial real-terms tightening of the base threshold during 2015-2025 period, while accepted ICERs for routine STAs generally cluster around or below £30,000 per QALY. In contrast, we identified higher effective thresholds in several appraisals using the severity modifier (effective acceptance up to ~£50,000 per QALY) and in HST decisions for ultra-rare diseases, where most-plausible ICERs commonly fall in the range of £100,000-£300,000 per QALY.
CONCLUSIONS: Between 2015 and 2025, NICE’s implicit WTP per QALY appears to have declined in real terms for most STAs, while rising selectively via severity and ultra-rare disease routes. This de facto tiered threshold system may have implications for equity, transparency, and consistency in UK HTA decisions.
METHODS: We reviewed published NICE STA and HST guidance and committee papers (2015-2025) to extract reported or committee-preferred ICERs, appraisal route and application of modifiers (end-of-life, severity, HST). The £20,000-£30,000 range was inflation-adjusted using UK price indices. Accepted ICER ranges were summarized descriptively by appraisal context and disease area.
RESULTS: Inflation-adjustment suggests a substantial real-terms tightening of the base threshold during 2015-2025 period, while accepted ICERs for routine STAs generally cluster around or below £30,000 per QALY. In contrast, we identified higher effective thresholds in several appraisals using the severity modifier (effective acceptance up to ~£50,000 per QALY) and in HST decisions for ultra-rare diseases, where most-plausible ICERs commonly fall in the range of £100,000-£300,000 per QALY.
CONCLUSIONS: Between 2015 and 2025, NICE’s implicit WTP per QALY appears to have declined in real terms for most STAs, while rising selectively via severity and ultra-rare disease routes. This de facto tiered threshold system may have implications for equity, transparency, and consistency in UK HTA decisions.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HTA73
Topic
Health Technology Assessment
Topic Subcategory
Decision & Deliberative Processes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas