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

NICE is consulting on how we plan to implement the recently published EQ-5D-5L value set into our methods. We are doing this through our modular update process and we welcome feedback from all users and stakeholders.

The EQ-5D captures how someone's health affects their daily life and helps us compare the benefits of different treatments. A mathematical model called a 'value set' converts EQ-5D questionnaire responses to a utility value, which we use in economic models to estimate the cost effectiveness of a treatment. A value set is produced by collecting the public's views about what aspects of health-related quality of life matter most to them. A new value set for the EQ-5D-5L has recently been published (Rowen et al. 2026). It provides a more accurate picture of what matters to people today and will replace the value set used in NICE evaluations. We have worked closely with the researchers who developed the value set; our partners at Department of Health and Social Care (DHSC) and NHS England (NHSE); and EuroQol, the not-for-profit foundation that developed the EQ-5D instruments, to ensure that the new value set is robust and reliable. Adopting it will help NICE measure the health benefits of new treatments more precisely, which means we can better judge whether they offer good value for money.

Adopting the new EQ-5D-5L value set will affect cost-effectiveness results, and that will be determined by the balance between a treatment's effects on extending how long people live and improving health-related quality of life. In a small impact assessment using a sample of 39 decisions from 37 technology appraisals (Biz et al. 2026), cancer medicines became more cost effective with the EQ-5D-5L value set. For medicines that treat non-cancer conditions, the impact was mixed. Medicines that improved health-related quality of life but did not affect how long people with non-cancer conditions live became less cost effective. Medicines that helped extend how long people with non-cancer conditions live mostly became more cost effective, but not in all cases.

Adopting the EQ-5D-5L value set is unlikely to change the severity weighting applied to most technology appraisal decisions. This conclusion is based on an analysis using the same sample of 39 technology appraisal decisions, plus 18 additional decisions (Wailoo et al. 2026).

Based on the results of our impact assessments, NICE recognises that some people, including those with certain chronic and disabling conditions, could potentially be negatively impacted by adopting the EQ-5D-5L value set, because treatments for their conditions may become less cost effective than under NICE's current approach of using the EQ-5D-3L value set. But, the new value set reflects an evidence-based methods improvement that will allow NICE to more accurately estimate the health benefits and cost effectiveness of new technologies consistently across our evaluations, regardless of the condition being treated. We will mitigate against any negative impact by promoting existing flexibilities in our methods. A full equality and health inequality impact assessment (EHIA) is provided as part of this consultation.

The methods update will affect NICE's technology appraisal and highly specialised technologies guidance manual (PMG36) and developing NICE guidelines manual (PMG20). We will amend these to stipulate that stakeholders preparing evidence submissions for NICE should use the EQ-5D-5L descriptive system and value set (Rowen et al. 2026) for reference-case analyses. If data has been collected using the EQ-5D-3L descriptive system, we will require it to be mapped onto the EQ-5D-5L value set. The EQ-5D-5L will also be required in any HealthTech evaluations that require cost–utility analyses. However, NICE's HealthTech programme manual (PMG48) does not require any updates because it does not mention the EQ-5D and directs stakeholders to the technology appraisal and highly specialised technologies guidance manual for information on measuring and valuing health effects in cost–utility analyses.

The Decision Support Unit (DSU) has updated the instructions for implementing the mapping model and revised the relevant Technical Support Documents (Wailoo 2024, Wailoo et al. 2023). These resources are available to stakeholders as part of this consultation, for information purposes.