DRIVERS OF NICE ACCEPTANCE FOR HIGH ICER VALUES: A COMPARATIVE ANALYSIS OF TECHNOLOGY APPRAISALS (TA)
Author(s)
Roua ABBES, Engineer1, Ines Abdelghani, Phd2, Imen Soussi, Bioengineer2, Aleksandra Caban, Phd3, Samuel Aballea, MSc, PhD4, Mondher Toumi, MSc, PhD, MD5.
1Clever-access, Tunis, Tunisia, 2Clever-Access, Tunis, Tunisia, 3Clever-Access, Cracow, Poland, 4Clever-Access, Paris, France, 5Aix-Marseille University, Marseille, France.
1Clever-access, Tunis, Tunisia, 2Clever-Access, Tunis, Tunisia, 3Clever-Access, Cracow, Poland, 4Clever-Access, Paris, France, 5Aix-Marseille University, Marseille, France.
OBJECTIVES: This study investigates the factors associated with the acceptance of higher incremental cost-effectiveness ratios (ICER ≥£30,000/QALY) in National Institute for Health and Care Excellence (NICE) technology appraisals (TAs).
METHODS: We analysed NICE TA reports published between 2018 and 2025 using the NaviHTA database. Inclusion criteria were: (1) recommendation of the product for full indication or for a subpopulation; (2) cost-effectiveness result in North-East quadrant with an ICER published in report. For appraisals with multiple comparators, only the highest reported ICER was considered. Eligible appraisals were categorised into high-ICER (≥£30,000/QALY) and low-ICER (<£30,000/QALY) groups and reviewed to identify drivers of acceptance.
RESULTS: Of 179 TAs identified, 70 reported ICERs ≥£30,000/QALY, of which 56% received a positive recommendation. Oncology indications were more frequent in the high-ICER group than in the low‑ICER group (69% vs. 56%)), as were life-threatening disease areas (82% vs. 73%). Modest differences were observed for products targeting disease pathophysiology (77% vs. 74%) and for those demonstrating survival benefit (51% vs. 42%). When disease severity criteria were met, approval rates were markedly higher (94% vs. 40%), representing the strongest driver of acceptance. No meaningful differences were observed between ICER groups for patient‑reported outcomes (PROs) or level of unmet need.
CONCLUSIONS: Oncology indications, life-threatening disease areas, and fulfilment of disease severity criteria are the principal drivers of NICE acceptance at higher ICERs. With NICE raising the threshold to £35,000 per QALY in April 2026, determinants of acceptance for therapies with even higher ICERs should be reassessed.
METHODS: We analysed NICE TA reports published between 2018 and 2025 using the NaviHTA database. Inclusion criteria were: (1) recommendation of the product for full indication or for a subpopulation; (2) cost-effectiveness result in North-East quadrant with an ICER published in report. For appraisals with multiple comparators, only the highest reported ICER was considered. Eligible appraisals were categorised into high-ICER (≥£30,000/QALY) and low-ICER (<£30,000/QALY) groups and reviewed to identify drivers of acceptance.
RESULTS: Of 179 TAs identified, 70 reported ICERs ≥£30,000/QALY, of which 56% received a positive recommendation. Oncology indications were more frequent in the high-ICER group than in the low‑ICER group (69% vs. 56%)), as were life-threatening disease areas (82% vs. 73%). Modest differences were observed for products targeting disease pathophysiology (77% vs. 74%) and for those demonstrating survival benefit (51% vs. 42%). When disease severity criteria were met, approval rates were markedly higher (94% vs. 40%), representing the strongest driver of acceptance. No meaningful differences were observed between ICER groups for patient‑reported outcomes (PROs) or level of unmet need.
CONCLUSIONS: Oncology indications, life-threatening disease areas, and fulfilment of disease severity criteria are the principal drivers of NICE acceptance at higher ICERs. With NICE raising the threshold to £35,000 per QALY in April 2026, determinants of acceptance for therapies with even higher ICERs should be reassessed.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HTA320
Topic
Economic Evaluation, Health Technology Assessment
Disease
No Additional Disease & Conditions/Specialized Treatment Areas