Presentation (CTI)

OBJECTIVES: In March 2026, the National Institute for Health and Care Excellence (NICE) updated its incremental cost effectiveness ratio (ICER) threshold from £20,000 - £30,000 to £25,000 - £35,000 per QALY. However, NICE’s appraisal committees may select an acceptable ICER within this range. This research assessed how the new threshold range has been applied compared to the previous one.
METHODS: A targeted search was conducted of NICE technology appraisals (TAs) that had reached a positive or optimised recommendation since 1 April 2026, when the new cost-effectiveness threshold range came into effect. To provide a comparator period, TAs that received a positive or optimised recommendation between April and June 2025, under the previous threshold, were searched. For each appraisal, the committee's position on the acceptable ICER within the applicable threshold range was extracted.
RESULTS: 12 TAs under the new threshold and 13 under the previous threshold met the inclusion criteria. Whilst the exact ICER that was accepted by the committee was confidential, the Final Draft Guidance for each TA indicates whether the final ICER was below the threshold, within the threshold or above the threshold. The spread of ICERs around both new and old thresholds were as follows: • Below: new 8% (1); old 8% (1) • Lower end: new 17% (2); old 31% (4) • Middle: new 42% (5); old 46% (6) • Upper end: new 25% (3); old 15% (2) • Above: new 8% (1); old 0% (0).
CONCLUSIONS: Based on the appraisals conducted to date, NICE committees appear to be applying the new £25,000 to £35,000 threshold range in full. Compared with appraisals under the previous threshold, a greater proportion of new-threshold appraisals were positioned at the upper end, suggesting committees have not been hesitant to exceed the previous £30,000 upper limit, where justified, aligning with first-hand experience of new assessments.