UK Reviews Ministerial Power Over NICE Thresholds

Under the government’s proposal, ministers would be authorized to establish a new “standard cost-effectiveness threshold” without public consultation. The current proposal would raise the threshold to £25,000-£ 35,000 per QALY.

The UK government has opened a consultation on proposals that would hand ministers formal powers to set the cost-effectiveness thresholds used by the National Institute for Health and Care Excellence (NICE), triggering concerns over how medical technologies will be appraised and taken up across the NHS.

The government is suggesting transferring responsibility for NICE's cost-effectiveness thresholds from its independent board to ministers.

The consultation comes after confirmation earlier this month that NICE will start using the revised thresholds, which were brought in as part of a wider UK-US trade deal designed to increase pharmaceutical exports and improve supply chains.

NICE has utilized a threshold of £20,000–£30,000 per quality-adjusted life year for over two decades to determine if medicines and medical devices represent good enough value to be adopted into the NHS.

Under the government’s proposal, ministers would be authorized to establish a new “standard cost-effectiveness threshold” without public consultation. The current proposal would raise the threshold to £25,000-£ 35,000 per QALY.

Although this change might facilitate market entry for device manufacturers and developers of innovative technologies, there are concerns that decisions based traditionally on clinical and economic evidence may become subject to political influences.

The move has been presented as a way to align national priorities with broader economic and industrial goals, but it has also raised questions about long-term regulatory certainty and impartiality.

Throughout the consultation, the stakeholders would, in essence, balance the competing goals of innovation, fiscal sustainability, and regulatory independence.

While the government argues that ministerial directions will not be frequent, the sector continues to consider how the shift might impact investment decisions and long-term access to emerging technologies.

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