BACKGROUND: The National Institute for Health and Care Excellence (NICE) updated their health technology evaluation methods in January 2022. NICE replaced the end of life (EOL) criteria, which allowed a recommendation with an incremental cost-effectiveness ratio (ICER) of up to £50,000 per quality-adjusted life year (QALY), with a new severity modifier. This new approach considers absolute QALY shortfalls (AS) and proportional QALY shortfalls (PS) to determine relevant QALY weights and the willingness to pay (WTP) threshold to be applied.

OBJECTIVES: This study aimed to analyse technologies that were accepted with the EOL criteria and assess whether they would still receive additional QALY weighting if evaluated using the new criteria.

METHODS: NICE single technology appraisals (STA) between 2015 and 2021 were reviewed to identify technologies that were accepted for EOL criteria. Data required to estimate AS and PS were identified from company submissions. AS and PS weights were estimated using a published QALY Shortfall Calculator tool.

RESULTS: In total, 324 STAs with a positive recommendation conducted between 2015 and 2021 were screened. Of 72 STAs meeting EOL criteria, 32 submissions provided data required to estimate AS and PS. Reasons for exclusion included, confidential data (72.5%), missing data (20.0%), and inappropriate comparator (5.0%). Using the QALY Shortfall Calculator tool, 20 (62.5%) were found to be eligible for an additional 1.2x QALY weighting (WTP of £36,000/QALY), and 7 (21.9%) were found to be eligible for an additional 1.7x QALY weighting (WTP of £50,000/QALY) under the new severity modifier criteria.

CONCLUSIONS: The results of this study indicate that technologies previously eligible for EOL criteria are unlikely to receive the same benefits under the new severity modifier, with only 21.9% of technologies still able to receive a WTP of £50,000/QALY. Future research should focus on the appraisals that are now likely to be eligible for a severity modifier.