The Importance of the NICE Methods Review
Imagine a groundbreaking new drug for a devastating disease. It works in clinical trials, but will it reach patients? In England, the answer often hinges on the National Institute for Health and Care Excellence (NICE). For 25 years, NICE has served as the gatekeeper, determining which new treatments represent good value for the National Health Service (NHS) 6 . Its decisions can mean the difference between life and death, or between a life of suffering and one of improved quality.
We are now in the age of one-time gene therapies, personalized cancer medicines, and artificial intelligence (AI)-designed drugs.
This article explores how NICE is fundamentally reforming its processes through a continuous "methods review" to ensure the NHS can benefit from the latest scientific breakthroughs.
NICE is internationally respected, with countries like Spain using its framework as a gold standard for their own health systems 6 . Its core mission is health technology assessment (HTA), a systematic process for evaluating the clinical effectiveness, cost-effectiveness, and broader impact of medicines, medical devices, and diagnostics 1 .
The fundamental principle is the Quality-Adjusted Life Year (QALY), a measure that combines the length and quality of life gained from a treatment.
NICE's famous "cost-effectiveness threshold" suggests that interventions costing between £20,000 and £30,000 per QALY gained typically represent good value for the NHS 6 . This creates a clear, though often debated, benchmark for new technologies.
This system, however, is being strained by modern pharmaceuticals. New therapies, especially for complex conditions like Alzheimer's disease or rare cancers, present new challenges for assessors 6 :
Sticking to rigid, outdated evaluation methods could block patient access to vital innovations. As one analysis noted, NICE already makes many "optimised" recommendations, which limit a drug's use to a narrower population than its license specifies—a practice that has been increasing over time .
Recognizing these challenges, NICE has moved away from a major revision of its rulebook every decade. In its place, they have introduced a dynamic and responsive modular update process 4 6 .
This new framework allows NICE to make smaller, more frequent updates to specific sections of its manual, keeping its methods "flexible and responsive to research advances" 4 . It also opens the door for stakeholders, including pharmaceutical companies and patient groups, to suggest areas for improvement 4 . This is a significant shift towards a more collaborative and agile system.
The modular process is already delivering critical updates. Recent and planned changes include:
A major update now explicitly guides manufacturers on how to analyze a technology's potential impact on health inequalities. It promotes techniques like distributional cost-effectiveness analysis.
An upcoming module will integrate a new UK value set for the EQ-5D-5L, a key questionnaire used to calculate QALYs, ensuring they reflect public preferences more accurately.
Another planned update will provide clearer guidance on using surrogate endpoints in cost-effectiveness models, which is crucial for assessing early evidence for innovative drugs.
One of the most significant innovations to emerge from NICE's new approach is the Early Value Assessment (EVA). Designed for promising medical technologies and diagnostics, the EVA is a real-world experiment in accelerating access while managing risk 3 8 .
The EVA process is tailored for technologies with immature evidence bases. According to NICE's HealthTech manual, the methods are adapted for speed and pragmatism 3 :
Because full clinical data may be lacking, economic models can use surrogate outcomes and make larger assumptions than would be acceptable in a full appraisal 3 .
| Evaluation Type | Description | Use Case in EVA |
|---|---|---|
| Cost-Utility Analysis | Measures benefits in QALYs; allows comparison across diseases. | Used when there is some data linking the technology to quality of life. |
| Cost-Effectiveness Analysis | Measures benefits in natural units (e.g., heart attacks prevented). | Used when disease-specific outcomes are the most reliable evidence. |
| Cost-Comparison Analysis | Focuses on comparing costs between technologies for similar outcomes. | Used when clinical effectiveness is similar, but costs differ. |
| Cost-Consequence Analysis | Presents costs and various outcomes in a disaggregated list. | Used when a single measure of benefit is not appropriate. |
The outcome of an EVA is not a simple "yes" or "no." The committee can issue a conditional recommendation for use in the NHS, meaning the technology can be adopted while further evidence is collected to address remaining uncertainties 3 8 .
As of 2025, seven technologies conditionally recommended through the EVA program have received £7.8 million in government funding to gather real-world evidence, accelerating their path to full adoption 8 .
| Recommendation Type | Meaning for the NHS | Funding Implications |
|---|---|---|
| Can be used | Technology should be routinely available. | Paid for using core NHS funding. |
| Can be used during evidence generation | Technology can be used as an option while more data is collected. | Paid for using core NHS funding; company often funds evidence collection. |
| More research is needed | Not enough evidence to support NHS funding. | Access only through company, research, or non-core NHS funding. |
| Should not be used | Technology does not offer benefit or value for money. | Not funded by the NHS. |
The work of NICE and its assessment groups relies on a sophisticated toolkit of methodologies and frameworks. Below are some of the essential "research reagents" in the world of HTA.
A composite measure of survival and quality of life that allows comparisons of effectiveness across different disease areas.
Outcome MeasureModels how the costs and health benefits of a technology are distributed across different societal groups, helping to address health inequalities.
Analytical MethodData on patient health and care collected from routine clinical practice (e.g., electronic health records). Crucial for validating EVA conditional recommendations.
Data SourceA measure (e.g., blood test result) used as a substitute for a direct measure of how a patient feels or survives. Speeds up assessment when long-term data is unavailable.
Outcome MeasureA "safe space" for NICE to co-develop new assessment methods with industry and academics without impacting live appraisals 6 .
Innovation PlatformNICE's evolution continues. The 2025 conference highlighted several future-focused initiatives 6 :
AI is already being used to streamline evidence synthesis, design clinical trials, and even draft regulatory submissions. NICE has published a position statement on using AI in evidence generation and is exploring how to evaluate AI-based technologies themselves.
To tackle challenges like antimicrobial resistance, NICE and NHS England are piloting subscription-style contracts for antibiotics. This model pays a fixed annual fee based on the drug's value to the NHS, rather than the volume used, creating a viable market for these essential medicines 6 .
There is a growing push for open-source modeling and greater transparency in how decisions are made. NICE is also deepening its partnership with the Medicines and Healthcare products Regulatory Agency (MHRA) to align regulatory and HTA processes from the start 6 .
NICE established to provide national guidance on treatment and care in the NHS
Introduction of Value-Based Assessment proposals to refine the QALY approach
Launch of the modular update process for more agile methods review
Introduction of Early Value Assessment (EVA) for promising technologies with immature evidence
Focus on AI integration, novel payment models, and enhanced transparency
The review of NICE's methods is a critical, ongoing journey to keep pace with the breathtaking speed of pharmaceutical innovation. Through the modular update process, innovative pathways like EVA, and a commitment to collaboration, NICE is building a more agile and responsive system.
The ultimate goal remains unchanged: to ensure that patients receive effective, innovative treatments in a timely manner, while ensuring the financial sustainability of the NHS. In a world of constant scientific discovery, the work of evaluating value is never finished. It is this commitment to evolution that will ensure the UK remains at the forefront of providing cutting-edge, cost-effective care for all.