Presentation (CTI)

OBJECTIVES: On 1^st December 2025, NICE announced it was raising its acceptable Incremental Cost-Effectiveness Ratio (ICER) threshold from the long-standing £20,000-£30,000 to £25,000-£35,000 per QALY gained, with the new range taking effect on 24^th March 2026. The increased thresholds aim to improve patient access to innovative high-cost therapies in the UK, and this study examines whether early appraisal data supports this objective.
METHODS: We conducted a retrospective analysis of NICE single technology appraisal (STA) outcomes using publicly available guidance data. Outcomes from the post-ICER threshold increase period (24th March - 25th June 2026; n=54) and the post-announcement period (1st December 2025 - 24th March 2026) were compared against 6-month (n=27), 1-year (n=76), and 3-year (n=217) pre-announcement baselines.
RESULTS: Early post-announcement data showed no discernible improvement in NICE outcomes; whereas the post-implementation period showed measurable gains in both recommendation rates and manufacturer engagement. Recommendation rates stood at 23.3% post-announcement and 42.3% post-implementation, compared with 33.0% in 2025 and 36.2% across 2023-2025. Terminated appraisals due to manufacturer non-submissions fell to 19.2% post-implementation versus 26.7% in the early post-announcement period and 24.2% in 2025, representing >20% relative reduction. Furthermore, non-recommended outcomes fell to 0% post-announcement, though this should be interpreted cautiously given small sample sizes and NICE's stated intention to pause borderline appraisals pending threshold implementation.
CONCLUSIONS: Early evidence suggests the NICE ICER increase has translated into improved appraisal outcomes, though the impact was not immediate. Outcomes initially deteriorated post-announcement, potentially reflecting a strategic pause from manufacturers. Following formal implementation on 24h March 2026, an improvement was observed: manufacturer non-submission rates have reduced for the first time in 3-years and positive recommendations have drastically increased, suggesting that increased willingness-to-pay has somewhat mitigated manufacturer concerns around Most Favoured Nation (MFN) pricing policy. Continued monitoring will be essential to determine whether threshold changes ultimately deliver improved patient access.