How have NICE committees applied the new cost-effectiveness threshold of £25,000 to£35,000 per QALY?

Introduction

From 1 April 2026, the National Institute for Health and Care Excellence (NICE) has raised its incremental cost-effectiveness ratio (ICER) threshold from £20,000 – £30,000 to £25,000 – £35,000 per QALY1
NICE’s appraisal committees determine the ICER within, or below, this range that is considered cost-effective depending on the level of uncertainty in the economic case, where greater uncertainty will lower the ICER that is considered cost-effective
According to NICE’s process and methods guide, committees should accept greater uncertainty if the indication is rare or there is a particular unmet need1
How committees are applying the new cost-effectiveness threshold has not yet been well characterised

Assess how the new £25,000 – £35,000 per QALY threshold range has been applied, and where within that range have ICERs been considered acceptable
Compare the distribution of acceptable ICERs with appraisals conducted under the previous £20,000–£30,000 per QALY range
Assess if the distribution varies across therapeutic area

Based on the appraisals conducted to date, NICE committees appear to be applying the new £25,000 to £35,000 threshold range in full
Compared with appraisals under the previous threshold, the same proportion of TAs where the new thresholds applied were positioned at the upper end,
suggesting committees have not been hesitant to exceed the previous £30,000 upper limit, where justified, aligning with first-hand experience of new assessments
However, in TAs of indications other than oncology / haematology, there are a greater number of acceptable ICERs below the £25,000 threshold, which may suggest that for some products / indications committees were more stringent with applying the higher CE thresholds