OBJECTIVES: In 2022, NICE introduced a severity modifier weighting replacing the end-of-life criteria. The severity modifier broadens the assessment of severity from treatments at end-of-life to include assessment of severity of all conditions. If a company demonstrates a specified level of severity for the indicated population (through meeting either an absolute or a proportional quality-adjusted life year [QALY] shortfall threshold), a weight of 1.2 or 1.7 is applied to the incremental cost-effectiveness ratio denominator.

METHODS: All documentation relating to eligible TAs was accessed from the NICE website (21st June 2024). Eligibility was defined as an appraisal having a final scope dated after January 31^st, 2022, and a published technology appraisal guidance. The term ‘severity modifier’ was searched for in all documents. If not mentioned, it was assumed that the company did not apply to use a severity modifier weighting. The remaining TAs were screened to determine if the company calculated the QALY shortfall, whether the thresholds were met and whether the committee accepted the resulting severity modifier weighting.

RESULTS: Of the 84 eligible TAs, the company calculated the QALY shortfall in 35 submissions. Of the 35 submissions, 40.0% did not meet either threshold, 31.4% were accepted with a 1.2 severity weighting, 11.4% with a 1.7 weighting, and 5.7% with 1.2 and 1.7 weighting (>1 indication). In the remaining 11.4%, the companies submitted with a severity modifier but the severity modifier weighting of 1.2 was rejected by the committee.

CONCLUSIONS: The severity modifier is applicable to a broad range of severe indications, and of those that met the criteria, the majority achieved the lower 1.2 severity weighting.