Presentation (CTI)

OBJECTIVES: Increases to the standard acceptable threshold range used by the National Institute for Health and Care Excellence (NICE), from £20,000-£30,000 per quality-adjusted life year (QALY) to £25,000-£35,000 per QALY, were confirmed on 1 December 2025 and came into effect on 1 April 2026. Given the room for committee discretion within and beyond these ranges and to understand the potential consequences of this change, analysing evidence on what NICE committees considered to be acceptable incremental cost-effectiveness ratios (ICERs) in the year leading up to 1 April 2026 is of interest, and was the aim of this research.
METHODS: Single or multiple technology appraisals (TAs) with final draft guidance published 1 April 2025 to 31 March 2026 were identified. Guidance wording on cost-effectiveness results and acceptable ICERs were extracted and analysed.
RESULTS: Fifty-three relevant TAs were identified. Committee positions on acceptable ICERs were routinely reported and justified across TAs. Typical wording was “around £20,000”, “around £30,000”, or “towards the [lower end / middle / upper end] of the range”, leaving some room for discretion. Committee positions were justified with reference to NICE manual wording. No clear trends in positions were identified across committees or over time. There was no notable move to accept higher ICERs following the 1 December announcement, in anticipation of the threshold change.
CONCLUSIONS: Evidence from the year leading up to the April 2026 threshold range change suggests NICE committees make decisions in line with directions from the NICE manual, and that acceptable ICER considerations are consistent across committees. This evidence suggests that committees will report higher acceptable ICER decisions from 1 April 2026, as the UK Government intended.