Modular update to NICE manuals EQ-5D-5L value set: Evidence review document

As part of our equality and health inequality impact assessment (EHIA), we reviewed the 214 most recently published NICE technology appraisals (at the time of the analysis; published between 22 March 2023 and 8 October 2025) to identify treatments that might have been less cost effective if the 5L value set had been used. We focused on medicines that did not affect how long people with non-cancer conditions live, because these interventions became less cost effective in the sample used for EEPRU's impact assessment, and found 39 appraisals. We also considered the limited evidence from DSU's impact assessment that adopting the 5L value set may be less favourable for younger people than for older people.

Assessing the equalities and health inequalities relevant to these 39 appraisals identified several populations that may be negatively affected by adopting the 5L value set and that could also qualify as disabilities under the Equality Act 2010. These include people with multiple sclerosis, Duchenne muscular dystrophy and ulcerative colitis. We also identified groups with other protected characteristics, as well as groups with wider determinants of poor health, who may be negatively affected by adopting the 5L value set because treatments for conditions more common in these groups may become less cost effective. There are also some populations that are likely to be positively affected by adopting the 5L value set. These include people with cancer, which qualifies as a disability under the Equality Act 2010, and other conditions where treatment can extend how long someone lives. Full details are in the equality and health inequality impact assessment (EHIA) document provided as part of this consultation.

Notwithstanding the impact assessment identifying a disproportionate adverse impact for some groups of people, adopting the 5L value set reflects an evidence-based improvement to NICE's methods and will allow us to more accurately estimate the health benefits and cost effectiveness of new technologies consistently across our evaluations, regardless of the condition being treated. Recognising the disadvantage caused to some groups of people, we will provide committees with briefing materials and training, including information on the impact of adopting the 5L set. These will draw attention to the populations (and related equalities and health inequalities issues) that could potentially be negatively impacted because treatments become less cost effective. We will also explain the potential impact of adopting the 5L value set on the severity weightings applied in technology appraisal decisions. The briefing materials and training will also promote awareness of existing methods and processes for identifying and addressing equalities and health inequalities issues, how the committee can apply flexibility in its decision making when considering these factors, and provision for reasonable adjustments around requiring EQ-5D data (that is, accepting evidence from other health-related quality of life measures when there is evidence that the EQ-5D is not appropriate).