NICE Raised Its Standard Threshold to £25,000–£35,000 per QALY in April 2026

NICE’s standard cost-effectiveness threshold, used by technology appraisal committees to judge whether a medicine is a cost-effective use of NHS resources, increased by 25 per cent, from £20,000–£30,000 to £25,000–£35,000 per QALY gained. NICE stated that the change would take effect in April 2026. It applies to the technology appraisals programme and not to the highly specialised technologies programme, which already uses a higher threshold.

NICE’s analysis, as reported by NICE, suggests that the higher threshold will allow it to recommend an additional three to five new medicines or indications each year. Commentators have linked the change to wider UK–US trade discussions on medicines, and the Office of Health Economics notes that the timetable raises the prospect of a further review of the threshold in around three years.

Industry commentary describes the change as the first increase in NICE’s threshold in 26 years. It alters the reference point used in every technology appraisal committee discussion of cost-effectiveness. A higher range does not mean that every technology with an incremental cost-effectiveness ratio below £35,000 per QALY will be recommended. Committees continue to consider the plausibility of the estimates, the degree of uncertainty and other factors described in the manual before reaching a view on the most plausible ICER and on whether it represents a cost-effective use of NHS resources.

Before 2026, ministers had no power to direct NICE on the level of its threshold. The government’s response to its consultation on changes to the NICE regulations set out that it would amend the regulations to give ministers a limited power of direction to set the core cost-effectiveness threshold. A parliamentary answer indicates that the statutory instrument was laid on 3 March 2026 and was due to come into force on 24 March 2026, with implementation in April following a ministerial direction. The exact date of the direction could not be confirmed from the sources reviewed.

NICE’s manual update information for PMG36 lists a March 2026 update incorporating the new cost-effectiveness threshold. It also lists a later update, dated October 2026, on varying the funding requirement to take account of net budget impact. NICE has run further modular updates during 2026, including work on carer health-related quality of life and on utility values; their final status should be checked on the NICE website.

NICE explained that committees would use the new threshold in meetings held from the date the change took effect, and that meetings held before then would proceed using the £20,000–£30,000 range. Topics that were not cost-effective under the old range but might be under the new one were to be paused before draft guidance and restarted once the new threshold applied.

NICE’s implementation document states that, once the new threshold is applied, the maximum acceptable incremental cost-effectiveness ratio previously set by a committee under the old thresholds will be raised automatically by £5,000. NICE also stated that the change will not lead to reviews of appraisals already completed.

For companies, the transitional rules mean that the timing of a committee meeting can affect the threshold applied. Topics that had been paused were to restart once the new threshold took effect, which may have changed the expected timetable for draft guidance and final guidance. Companies whose topics were paused should confirm the restart timetable with NICE and consider whether their commercial proposals need to be revisited in light of the revised range.

Companies with products in appraisal should consider whether their base-case and scenario results fall within the revised range, and how committee judgements on uncertainty, severity and other factors might interact with it. The threshold remains a range rather than a single figure, and committees continue to consider the degree of uncertainty and other factors set out in the manual when deciding where within the range a technology falls.

Market access teams should also review commercial strategy in light of the separate funding variation process for technologies with high net budget impact, which NICE updated in its manual in 2026. This summary is provided by Pubrica for information only and does not constitute advice from or on behalf of NICE.

Evidence quality remains central. A technology whose base-case ICER sits within the revised range but whose evidence is highly uncertain may still face a negative recommendation or a recommendation limited to a subgroup. Companies should therefore continue to invest in robust evidence on key model drivers, such as treatment effect duration and health-related quality of life, rather than relying on the higher threshold alone.