Equity and Applicability of the NICE Severity Modifier in Long-Term Late-Onset Conditions: A Review of Recent Technology Appraisal
Author(s)
tobyn eagles, PhD, Louise Crathorne, BA, MSc, Hayley Hogan, PhD.
Alzheimer's Society, London, United Kingdom.
Alzheimer's Society, London, United Kingdom.
OBJECTIVES: NICE introduced the severity modifier in 2022 to replace and expand its end-of-life (EOL) criteria, aiming to improve equity in health technology assessment (HTA) by giving greater weight to health gains in severe conditions. Eligibility is based on absolute (AS) or proportional (PS) quality-adjusted life year (QALY) shortfall. As younger individuals have more potential future QALYs to lose, conditions affecting them often score higher on AS than those affecting older populations. Although intended to better reflect burden across a broader range of conditions than the EOL criteria, the modifier may still undervalue long-term, progressive, late-onset diseases with diffuse and prolonged impacts not well captured in standard QALY models. This review assesses how the severity modifier has been applied in recent NICE technology appraisals (TAs) for long-term, progressive conditions, and whether its use reflects real-world disease burden, especially in older populations.
METHODS: A structured review of NICE TAs published since 2022 was conducted. NICE TAs were included if they addressed long-term, progressive illness with significant burden during later life (e.g. dementia, Parkinson’s disease, heart failure). For each, we recorded whether a case for the severity modifier was made, whether it was applied, whether AS and/or PS thresholds were met, the QALY weight used (if applicable), and whether the application aligned with the documented burden.
RESULTS: Preliminary findings indicate the severity modifier has been rarely applied to late-onset, high-burden conditions, largely due to thresholds not being met under QALY shortfall calculations.
CONCLUSIONS: Although intended to promote equity in HTA, the modifier’s current design may limit its applicability to older populations and progressive conditions. This creates a disconnect between formal use and real-world burden. A review of the methodology is recommended, with scope to adapt it for appraising late-onset, long-term conditions like dementia.
METHODS: A structured review of NICE TAs published since 2022 was conducted. NICE TAs were included if they addressed long-term, progressive illness with significant burden during later life (e.g. dementia, Parkinson’s disease, heart failure). For each, we recorded whether a case for the severity modifier was made, whether it was applied, whether AS and/or PS thresholds were met, the QALY weight used (if applicable), and whether the application aligned with the documented burden.
RESULTS: Preliminary findings indicate the severity modifier has been rarely applied to late-onset, high-burden conditions, largely due to thresholds not being met under QALY shortfall calculations.
CONCLUSIONS: Although intended to promote equity in HTA, the modifier’s current design may limit its applicability to older populations and progressive conditions. This creates a disconnect between formal use and real-world burden. A review of the methodology is recommended, with scope to adapt it for appraising late-onset, long-term conditions like dementia.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
PT36
Topic
Economic Evaluation, Health Policy & Regulatory, Health Technology Assessment
Topic Subcategory
Value Frameworks & Dossier Format
Disease
Neurological Disorders