# NICE technology appraisal methods (2022)

Source: https://onco.cc/terms/nice-methods/  
OnCo record `nice-methods` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The rulebook NICE uses to decide whether the NHS in England should pay for a medicine: a cost per quality-adjusted life year usually between 20,000 and 30,000 pounds, with extra weight since 2022 for severe diseases in place of the old bonus for end-of-life cancer drugs.

## Summary

United Kingdom (England and Wales), methods guidance with statutory force through NHS funding directions. NICE's health technology evaluations manual (process and methods guide PMG36) took effect on 1 February 2022 after a methods review that began in 2019, replacing the 2013 methods guide. Primary text: the NICE manual page. The NHS is legally obliged to fund technologies NICE recommends, normally within three months.

What the methods say: NICE compares the cost per quality-adjusted life year (QALY) gained with a range of 20,000 to 30,000 pounds, with a 3.5 percent discount rate. The 2022 manual introduced a severity modifier that weights health gains by 1.2 or 1.7 for conditions with large absolute and proportional shortfalls in quality-adjusted life expectancy, replacing the end-of-life criteria that since 2009 had allowed a weight of about 1.7 for treatments extending life by three months or more in patients with under two years to live, a rule that mainly benefited cancer drugs. The manual also accepted more uncertainty in rare diseases, formalised managed access through the Cancer Drugs Fund and the Innovative Medicines Fund, and allowed a broader view of real-world evidence. Highly specialised technologies for very rare diseases have a separate threshold of 100,000 pounds per QALY, rising with the size of the benefit.

The arguments: cancer charities fear that the severity modifier helps fewer cancer drugs than the end-of-life rule did, and NICE's own analysis anticipated a shift toward other diseases; economists argued the old rule was unfair to other patients. The threshold itself has not risen since 1999, which industry calls a real-terms cut and which the 2024 voluntary pricing scheme negotiation revisited without changing.

## Fields

- Kind: Term
- Last checked: 2026-09-17
- Also known as: NICE methods; NICE methods review; NICE manual; PMG36; severity modifier; end-of-life criteria; cost per QALY threshold; NICE threshold; technology appraisal process
- Tags: law; uk

## Sources

- NICE: health technology evaluations, the manual (PMG36): https://www.nice.org.uk/process/pmg36

## Connected records

- terms: [AMNOG (Germany, 2011)](https://onco.cc/terms/amnog/), [Cancer Drugs Fund (England)](https://onco.cc/terms/cancer-drugs-fund/), [EU HTA Regulation (EU) 2021/2282: joint clinical assessments](https://onco.cc/terms/eu-hta-regulation/), [Financial toxicity](https://onco.cc/terms/financial-toxicity/), [Health technology assessment (HTA), reimbursement and QALYs](https://onco.cc/terms/hta/), [ICER and health technology assessment](https://onco.cc/terms/icer-value-assessment/), [ILAP (Innovative Licensing and Access Pathway)](https://onco.cc/terms/ilap/), [Innovative Medicines Fund (England)](https://onco.cc/terms/innovative-medicines-fund/), [Quality of life and patient-reported outcomes (QoL, PRO)](https://onco.cc/terms/qol-pro/)
- collections: [NICE cancer guidance and technology appraisals (UK)](https://onco.cc/collections/nice-guidance/)
- institutions: [National Institute for Health and Care Excellence](https://onco.cc/institutions/nice/), [Scottish Medicines Consortium](https://onco.cc/institutions/smc/)
- bottlenecks: [Prices and value](https://onco.cc/bottlenecks/b-drug-pricing/)

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