OBJECTIVES: In November 2023, the Institute for Clinical and Economic Review (ICER) published an update to its Value Assessment Framework, implementing a non-zero approach to their modified societal perspective. By contrast, the National Institute for Health and Care Excellence (NICE) 2022 Methods Guide update did not recommend a societal perspective as part of their appraisals. The aim of this study was to identify the respective benefits of the societal versus health service perspectives recommended by ICER and NICE, and consider whether there could be value in NICE adopting a similar societal framework in its economic evaluations.

METHODS: A qualitative comparison of the NICE and ICER frameworks was conducted for products which underwent appraisal by ICER from 2020 to 2023 (n=35), comparing results of the NICE and ICER appraisals for the same products. In these cases, where NICE did not recommend the treatments due to prohibitively high incremental cost-effectiveness ratios (ICERs), a qualitative analysis was conducted. This analysis examined how the NICE cost-effectiveness appraisal may have been impacted by utilizing the modified societal perspective from the ICER framework, investigating whether the cost-effectiveness of these products may have been improved and the funding decision changed. Special attention was given to recent NICE assessments related to cystic fibrosis, such as Kaftrio, Orkambi and Symkevi.

RESULTS: Our analysis shows that using either a modified societal perspective or the use of a non-zero approach into NICE's guidelines may highlight the previously unquantified improvements in productivity from treatments for cystic fibrosis.

CONCLUSIONS: Although a number of interventions were not recommended due to their high ICERs, their potential benefits on productivity and the substantial social burden borne by patients and carers warrants careful consideration. By introducing a more nuanced perspective using these wider societal approaches, NICE may enhance the relevance of its evaluations to the lives of the UK general public.