Presentation (CTI)

OBJECTIVES: The National Institute for Health and Care Excellence (NICE) reports that 85% of its recommendations are "positive", rising to 90% over the three years to 2025. However, 49% of positive decisions in this period were "optimised", recommended for a patient subgroup narrower than the technology's marketing authorisation. We measure patient access for optimised decisions to contextualise NICE's headline claim.
METHODS: Using NICE documentation, we calculated the proportion of patients granted access for each optimised decision using the M-score methodology previously developed by the authors: M=(p/P)*100, where P is the full population indicated in the UK marketing authorisation and the scope of the appraisal, and p is the subset eligible under NICE's recommendation. A score of 50 means that half of potential patients have access. We combined these scores with recommended decisions (M=100) and not-recommended decisions (M=0) to estimate overall access across all NICE decisions.
RESULTS: Between 2023 and 2025, NICE issued 228 technology appraisal decisions: 22 (10%) were not recommended and 206 (90%) were recommended, of which 101 (49%) were optimised. Sufficient data was available to calculate M-scores for 42 of the 101 optimised decisions (41%), giving a mean M-score of 34. The overall mean M-score was 61 across all 228 decisions, indicating that approximately 6 in 10 eligible patients gain access through NICE recommendations.
CONCLUSIONS: While 9 in 10 NICE decisions are positive, our analysis indicates access is achieved for around 6 in 10 eligible patients. Patient-weighted metrics such as the M-score provide a clearer picture of real-world access and should complement headline recommendation rates. OHE research is underway examining the drivers of NICE optimisation and to compare NICE approach to those of other similar HTA agencies.