OBJECTIVES: The National Institute for Health and Care Excellence (NICE) recently published their new combined methods, process, and topic selection manual. This includes the new severity modifier which replaces the prior End-of-Life (EoL) criteria and is expected to apply to a broader range of conditions compared to the EoL criteria. The severity modifier is based on two measures, the absolute and proportional quality-adjusted life year (QALY) shortfall. Our aim is to investigate the impact on QALY modifiers and cost-effectiveness thresholds if the severity modifier was applied in past appraisals.

METHODS: A targeted review of all NICE technology appraisals published in the last five years (June 2017 to May 2022) was conducted. Average age at diagnosis, female/male ratio, and discounted QALYs for standard of care comparators used in the economic analysis were extracted. The absolute and proportional QALY shortfall were calculated to determine severity level for each appraisal, and the relevant QALY modifiers were applied.

RESULTS: A total of 325 NICE appraisals were reviewed, with 106 (33%) appraisals containing sufficient unredacted figures to be included in the analysis. Of the 106 appraisals, a QALY modifier of 1 was applied to 63 (59%) appraisals, a QALY modifier of x1.2 was applied to 30 (28%) appraisals and a QALY modifier of x1.7 was applied to 7 (7%) appraisals. In 6 (6%) appraisals there were multiple QALY modifiers applied across included populations. Of the 7 appraisals where the highest QALY modifier was applied, 6 were in oncology and 1 was in multiple sclerosis.

CONCLUSIONS: A review of all NICE technology appraisals with unredacted data over the past 5 years has shown that only a small proportion will have the highest QALY modifier applied, resulting in a £50,000 cost-effectiveness threshold, although this analysis is limited by a high proportion of redacted appraisals.