Presentation (CTI)

OBJECTIVES: The National Institute for Health and Care Excellence (NICE) reference case stipulates a 3.5% annual discount rate for costs and health effects. A lower 1.5% rate is permitted in exceptional circumstances to better reflect long-term health benefits from potentially curative treatments. This review explored how NICE technology appraisals (TAs) have justified the use of the 1.5% discount rate and assessed resulting NICE recommendations.
METHODS: NICE TAs were searched from January 2007 to March 2026 using a TA database to identify appraisals that referenced the 1.5% non-reference discount rate in final guidance. TAs were assessed against three NICE criteria for the non-reference case discount rate: 1) significant improvement in length and quality of life, 2) restoration to full or near-full health, 3) sustained long-term benefits. Appraisals were categorised by whether these criteria were met, and reasons for non-acceptance were recorded.
RESULTS: 14 TAs were identified, of which 4 (28.6%) met the 1.5% criteria, while 10 (71.4%) did not. Accepted cases were predominantly in ultra-rare diseases or paediatric populations with strong evidence supporting long-term benefits. Key reasons for rejecting the 1.5% rate included differential discounting of costs and outcomes, irreversible disease manifestations preventing return to full health, and uncertainty around long-term benefits due to limited evidence. Despite variation in discount rate acceptance, the overall recommendation rate was high (93%).
CONCLUSIONS: NICE accepted the 1.5% discount rate in paediatric and early‑onset conditions, with strong evidence of long-term benefits, supported by trial data and expert input. This highlights NICE’s conservative application of the non-reference discount rate, which is applied only in exceptional circumstances and is largely inapplicable across most TAs.