Introduction
NICE uses cost-effectiveness thresholds in health economic evaluations to determine whether health technologies represent value for money for use in the NHS in England.
The Department of Health and Social Care (DHSC) has signalled its intent to increase the standard cost-effectiveness threshold that NICE uses in technology appraisals (TAs) from £20,000 to £30,000, to £25,000 to £35,000. In a health service funded by general taxation, it is right that the elected government makes decisions on overall spend levels.
NICE cannot implement this change until it receives a direction from the Secretary of State for Health and Social Care, and underpinning changes to the NICE regulations have been proposed by the DHSC to enable this. The DHSC has recently consulted on proposed changes to the NICE regulations to give the Secretary of State a power to direct NICE on the cost-effectiveness thresholds used in NICE evaluations.
Subject to parliamentary approval, DHSC processes and associated timelines, we anticipate that the DHSC will direct NICE to implement the increased threshold from April 2026. NICE will continue to engage closely with the DHSC, NICE users and wider stakeholders to anticipate and mitigate disruption should expected timelines change significantly.
NICE has communicated about the proposed changes with stakeholders for individual ongoing evaluations for which a committee meeting has already been held and a pause has been requested. This information will be stated on the NICE website for transparency to the wider public.
The exact date that NICE will implement the increased threshold and publish updated manuals is dependent on when we receive the direction from the DHSC. We will draft updated manuals in advance so that they can be published as soon as the direction is received. From the point of such a direction, the relevant manuals will change the standard cost-effectiveness threshold from £20,000 to £30,000, to £25,000 to £35,000.
The thresholds associated with principle 7 of the NICE principles will also be updated, but no changes will be made to the text associated with the principle. Committees will still be asked to consider the opportunity cost of recommending a treatment, albeit at a higher value. This is because any recommendation will result in the displacement of funds that could be used to provide care or treatment elsewhere in the health service. No other changes to NICE's manuals will be made. NICE's committees will use the new standard cost-effectiveness threshold in any committee meetings that take place from the date that the manuals have been changed.
It is for the DHSC to decide which NICE guidance programmes a threshold change will apply to. The DHSC has confirmed only that the proposed changes will apply to NICE's TA guidance. We await a government decision on application of the threshold change to the HealthTech and guideline programmes. The DHSC has indicated that the threshold used for highly specialised technologies will remain unchanged.