A modular update is a review of methods and/or processes informing NICE’s guidance, that may result in an update to our manuals.
We use a framework for these updates to keep our methods flexible and responsive to changes in health and care. This framework ensures consistency in updating our manuals and helps prioritise important updates. It also allows for suggestions from external stakeholders in identifying the candidates for modular updates. This ensures that the manuals continue to meet our users' needs.
How do we choose and prioritise updates?
There are 3 main ways to determine and prioritise the need for modular updates:
- updates needed to deliver business priorities
- updates needed to reflect changes to how NICE operates
- updates selected from suggestions by internal and external stakeholders.
A public board paper, developed and reviewed by a cross-NICE working group, sets out how we will:
- identify and prioritise modular updates to the manuals
- review the evidence and propose changes to the manuals
- engage and consult with stakeholders
- implement the modular updates.
NICE is responsible for the final decision, when selecting which methods and process areas are suitable for a modular update.
The process
How you can suggest a modular update
The online form is now available for stakeholders to submit candidates for modular updates until 18 August 2025. The form collects the following information:
- respondent details (name, organisation, email, role)
- stakeholder group that the respondent represents (e.g. health care professional, academia)
- manual to be updated and any relevant sections, if known
- brief description of issue
- links with, or funding from, the tobacco industry
- supporting information.
Shortlisting and prioritisation of suggested modular updates 2024 to 2025
42 suggestions for modular updates were received from a range of stakeholders. Suggestions relating to the same topic were combined, leaving a total of 17 unique suggestions. 2 modular updates were selected in the 2024 to 2025 modular updates round.
The selected modular updates are:
- EQ-5D-5L value set
- surrogate endpoints.
While work on these modular updates will begin in 2025 to 2026, the EQ-5D-5L value set update in particular is anticipated to take longer than a year to complete.
Decisions for each of the 17 unique suggestions for modular updates are outlined in the summary of decisions table. Further information is available in the minutes of meetings of a standing committee responsible for overseeing modular updates (Word).
Summary of decisions
| Title | Description | Scoping document / consultation |
|---|---|---|
| EQ-5D-5L value set | To enable the adoption of the value set from the new UK valuation study for the EQ-5D-5L into NICE’s reference case. | Selected |
| Surrogate endpoints | To provide updated guidance on how surrogate endpoints can be used in cost-effectiveness modelling. | Selected |
| Critical appraisal and external validity of trial evidence | To clarify guidance on suitable tools (such as the Cochrane risk of bias tool to assess RCTs) to assess the internal and external validity of trial evidence. | Shortlisted but not selected |
| Structural uncertainty | To update the manuals on structural uncertainty to facilitate committees to make more robust decisions and requests for structural scenarios, without halting the process through the judgement that a model is ‘not fit for purpose’. | Shortlisted but not selected |
| Carer quality of life | To provide updated guidance on when and how carer quality of life should be incorporated into economic analyses. | Shortlisted but not selected |
| Publishing review protocols – guidelines | To review the current process for how and where NICE publishes review protocols. | Shortlisted but not selected |
| Discount rate | To update NICE’s discount rate from 3.5% to 1.5%. | Not shortlisted |
| Updating the threshold | To adjust NICE’s threshold upwards to reflect increases in taxation, healthcare budgets and the increase, in line with inflation, of NICE fees for appraisals. | Not shortlisted |
| Applying the threshold | To provide more openness and transparency regarding the criteria NICE uses to assess uncertainty and how this affects their application of the threshold. | Not shortlisted |
| Rare disease in HTA | To review issues related to the assessment of treatments for rare diseases, including a rarity modifier, definition of rare disease, improving transparency and flexibility of routing decisions and appeals, and incorporating carer quality of life. | Not shortlisted |
| Severity modifier | To remove the opportunity cost neutrality requirement for the severity modifier and basing the modifier on societal preferences. | Not shortlisted |
| Re-evaluation of reference biologics | To create a process for re-reviewing technology appraisals of reference biologic treatments upon the entry of biosimilars to the market. | Not shortlisted |
| The use of registry data to inform guidance | To provide updated guidance on the use of registry data for clinical and cost-effectiveness estimates. | Not shortlisted |
| Disruptive innovative therapies | To develop a new HTA approach for disruptive technologies, such as radioligand therapies, including an innovative approach to include high infrastructure costs. | Not shortlisted |
| Impact on productivity included in HTA | To explore the inclusion of productivity costs either within the base case or as a specific non-reference case flexibility. | Not shortlisted |
| Wider societal impacts of healthcare | To consider evolving NICE’s methods to allow full inclusion of wider societal impact to allow more patients to benefit from innovative medicines. | Not shortlisted |
| Preventative health modifier | To incorporate a preventive health modifier into NICE’s HTA framework. | Not shortlisted |
Modular updates in progress
| Title | Description | Scoping document / consultation |
|---|---|---|
| Health inequalities | This methods update will provide guidance on how to incorporate health inequalities considerations in technology evaluations. It will focus on methods for measuring health inequalities, considering quantitative evidence of how health interventions affect these inequalities, and how best to use this evidence in decision-making. | Complete – updated health technology evaluations manual published in May 2025 |
| HealthTech programme process update 1 | This update will set out a unified process for NICE's HealthTech teams (formerly DAP, MTEP, IP) and clarify this for external stakeholders. This update wilalso provide updated methods guidance for Early Valuation Assessments (EVAs). | Post-consultation updates and sign-off. Consultation for this update is now closed and the wording for the update is being finalised. |
| HealthTech programme process update 2 | This update will provide further clarification and update to methods used for NICE HealthTech guidance. | Draft recommendation. Consultation for this update is currently estimated to take place in 2025. |
| EQ-5D-5L value set | This update will enable the adoption of the value set from the new UK valuation study for the EQ-5D-5L into NICE’s reference case. | Scoping. This update was prioritised in February 2025. |
| Surrogate endpoints | This update will provide updated guidance on how surrogate endpoints can be used in cost-effectiveness modelling. | Scoping. This update was prioritised in February 2025. |