NICE cost-effectiveness range of £25,000 to £35,000 per QALY
Appraising a new treatment, NICE judges the cost per QALY (quality-adjusted life year, combining length and quality of life) gained against a standard range of £25,000 to £35,000.
Remember
The standard range of £25,000 to £35,000 per QALY gained guides the judgement of the NICE appraisal committee and is not an automatic rule: above £35,000 a stronger case is needed, and a figure inside the range does not guarantee funding.
NICE (National Institute for Health and Care Excellence) advises on which treatments the NHS in England should fund. To compare very different treatments, it uses the QALY (quality-adjusted life year), a score that combines how long a person lives with how good that life is. One year in perfect health equals 1 QALY.
NICE judges value for money by cost-effectiveness, which compares the extra NHS cost with the extra health benefit over the alternative. It divides the extra cost by the extra QALYs to give the cost per QALY gained. Since April 2026, the standard technology-appraisal range for this figure (used when NICE appraises a new treatment) has been £25,000 to £35,000 per additional QALY. Highly specialised technologies are a special case: NICE appraises them by different methods.
The range is a guide for judgement, not a fixed cut-off. Below £25,000 the decision normally rests on the cost-effectiveness estimate. As the figure rises through the range, the NICE appraisal committee looks harder at how uncertain the evidence is and at other factors. Above £35,000 per QALY gained, a stronger case is needed to support a recommendation.
NICE uses a range rather than one figure because it cannot know precisely what the NHS would give up elsewhere to fund a new treatment. If NICE recommends a treatment, local NHS organisations must be able to provide it, meaning they may have to take budget away from other things.
NICE also shows explicit reasoning: the rules and reasons are stated openly, so that its decisions are open to challenge.
Key facts
- Current range
- since April 2026, the standard technology-appraisal range has been £25,000 to £35,000 per additional QALY gained.
- One QALY
- one year in perfect health is worth 1 QALY.
- Cost per QALY
- the extra cost divided by the extra QALYs gained over the alternative.
- Above the range
- above £35,000 per additional QALY, a stronger case is needed to support a recommendation.
- Not automatic
- the range informs the judgement of the NICE appraisal committee and does not guarantee a recommendation or automatic funding.
- Explicit reasoning
- NICE states its rules and reasons openly so that its decisions are open to challenge.
Exam traps
- A stronger case is needed above about £35,000 per QALY gained, not above about £20,000 (the lower end of the earlier range of £20,000 to £30,000), because the current range runs from about £25,000 to £35,000 and a figure inside it is not refused merely for want of a stronger case.
- A cost per QALY inside the standard range does not mean a recommendation with little further scrutiny, because the NICE appraisal committee looks more closely at the justification, including uncertainty in the evidence, as the figure rises within the range.
- A cost per QALY gained is not a ceiling on the price paid for each patient, because it compares extra cost with extra health benefit.
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