OBJECTIVES:

The National Institute for Health and Care Excellence (NICE) have introduced a new severity modifier, based on quality-adjusted life year (QALY) shortfall (QS). End-of-life criteria previously used by NICE were limited to diseases with short life expectancy. Therefore, these did not apply to long-term, progressive conditions such as multiple sclerosis (MS). This research aims to assess the potential impact of this new severity modifier in MS by calculating QS in previous NICE MS appraisals.

METHODS:

Past NICE appraisals in MS were manually searched for on the NICE website on 6 May 2022. Only appraisals which reported modelled baseline characteristics and total discounted QALYs (required to calculate QS) were included. The lowest comparator total QALYs were taken to represent expected QALYs with the condition. Quality-adjusted life expectancy (QALE) was derived from English life tables (2018–2020) and 2014 Health Survey for England general population utility data, using reported model baseline characteristics. An annual discount rate of 3.5% was applied to calculated QALEs.

RESULTS:

The search returned 23 appraisals, of which 6 reported data sufficient for QS calculations. Absolute QS ranged from 13.37 to 16.61 QALYs. Proportional QS ranged from 0.72 to 0.86. In line with the new NICE methods guide, a severity modifier of x1.2 would have been applied to incremental QALYs in all six appraisals, driven by absolute QS. Scenario analyses using the highest comparator QALYs to represent expected QALYs with the condition found the same result.

CONCLUSIONS:

Severity of MS has not previously been quantitatively considered in past NICE appraisals in MS. This research suggests that NICE’s new severity modifier will result in a higher value being placed on incremental QALYs in future appraisals in MS.

Future research would investigate whether NICE’s severity modifier places additional weight on incremental QALYs in other long-term, progressive diseases, where end-of-life criteria did not previously apply.