EXAMINING NICE COST-EFFECTIVENESS THRESHOLDS ACROSS ONCOLOGY AND NON-ONCOLOGY APPRAISALS: DRIVERS OF DECISION-MAKING
Author(s)
Zuzanna Opuchlik, MSci, Berkeley Jack Greenwood, BA.
Newmarket Strategy Limited, London, United Kingdom.
Newmarket Strategy Limited, London, United Kingdom.
OBJECTIVES: National Institute for Health and Care Excellence (NICE) applies cost-effectiveness thresholds of £20,000-£30,000/QALY (£25,000-£35,000/QALY since April 2026), with higher thresholds, with higher thresholds applied under severity modifiers or to account for uncaptured benefits. This research aims to identify, and catalogue thresholds assigned in recent NICE technology appraisals (TAs) and examine the committee rationale underpinning those thresholds.
METHODS: All NICE TAs with a positive recommendation published between 1 January 2025 and 1 April 2026 were identified. The acceptable ICER, committee rationale and type of commercial arrangement were extracted. TAs that did not report the thresholds or were updates of prior appraisals were excluded.
RESULTS: Fifty-six appraisals were identified, out of which 36 were in oncology and 20 in non-oncology. In oncology, 10/36 were accepted at the mid-range threshold; in non-oncology, 11/20 were around the lower. On average, non-oncology appraisals received lower thresholds. The primary drivers for the £20,000/QALY threshold in oncology were significant uncertainty around long-term outcomes, such as overall survival, and evidence generalisability. Lung cancer was the most common type of oncology indication (8 TAs), with majority (6/8) accepted at the mid-range ICER. Second most common were blood cancers, where more variation was observed and a higher threshold was accepted in 4/9 appraisals. Twenty-two appraisals include a patient access scheme (PAS), 10 had a commercial agreement, 2 had both and 1 was priced via Medicines Procurement and Supply Chain. The man acceptable ICER differed by only ~£1,000 between appraisals with a PAS versus a commercial arrangement.
CONCLUSIONS: Oncology indications were more likely to receive mid-to-higher range thresholds than non-oncology. Within oncology, the primary determinant of a lower threshold was the strength and maturity of clinical evidence, particularly uncertainty around long-term survival outcomes. The near-identical acceptable ICERs across PAS and commercial arrangements suggest that neither mechanism offers a threshold advantage.
METHODS: All NICE TAs with a positive recommendation published between 1 January 2025 and 1 April 2026 were identified. The acceptable ICER, committee rationale and type of commercial arrangement were extracted. TAs that did not report the thresholds or were updates of prior appraisals were excluded.
RESULTS: Fifty-six appraisals were identified, out of which 36 were in oncology and 20 in non-oncology. In oncology, 10/36 were accepted at the mid-range threshold; in non-oncology, 11/20 were around the lower. On average, non-oncology appraisals received lower thresholds. The primary drivers for the £20,000/QALY threshold in oncology were significant uncertainty around long-term outcomes, such as overall survival, and evidence generalisability. Lung cancer was the most common type of oncology indication (8 TAs), with majority (6/8) accepted at the mid-range ICER. Second most common were blood cancers, where more variation was observed and a higher threshold was accepted in 4/9 appraisals. Twenty-two appraisals include a patient access scheme (PAS), 10 had a commercial agreement, 2 had both and 1 was priced via Medicines Procurement and Supply Chain. The man acceptable ICER differed by only ~£1,000 between appraisals with a PAS versus a commercial arrangement.
CONCLUSIONS: Oncology indications were more likely to receive mid-to-higher range thresholds than non-oncology. Within oncology, the primary determinant of a lower threshold was the strength and maturity of clinical evidence, particularly uncertainty around long-term survival outcomes. The near-identical acceptable ICERs across PAS and commercial arrangements suggest that neither mechanism offers a threshold advantage.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HTA354
Topic
Economic Evaluation, Health Technology Assessment, Organizational Practices
Topic Subcategory
Decision & Deliberative Processes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology