Science policy and methods projects

Antimicrobial subscription model - a new way to evaluate and pay for antimicrobials

To incentivise the development of new antimicrobials, we worked with NHS England and the Department of Health and Social Care to develop, pilot and implement a world-first subscription payment model. In the new model, antimicrobial manufacturers are guaranteed a fixed annual payment for their drugs, regardless of volumes sold. This is part of the UK national action plan to tackle antimicrobial resistance. When the subscription model was launched in August 2024, only traditional antibiotics were eligible. NICE’s Health Technology Assessment Innovation Laboratory (HTA Lab) is exploring extending the model to a wider range of antimicrobial products.

EQ-5D-5L valuation set for England

We’re advising on a valuation study to generate a new EQ-5D-5L value set for the UK. The study is being undertaken by a research team comprising investigators from across the UK, and is being overseen by a steering group which includes representatives from EuroQol, NICE, the Department of Health and Social Care, and NHS England.  

EQ-HWB

EQ-HWB (EQ Health and Wellbeing instrument) is a new standardised measure of of health and wellbeing that was created following the Extending the QALY research project that NICE contributed to.

The EQ-HWB has not been developed as a replacement for the EQ-5D, but as a different instrument that captures a broader range of impacts on people, their families and carers. Research is underway to validate the EQ-HWB and compare it with existing instruments. NICE supports this important research, which will help us to decide whether and how to use EQ-HWB to inform NICE evaluations in the future.

Environmental sustainability

NICE has a strategic objective to examine the potential to include environmental impact data in our guidance to reduce the carbon footprint of healthcare.

To support this objective, we’re exploring the feasibility of assessing the environmental impacts of competing medicines and health technologies where there’s little or no expected difference in health or cost outcomes. This work is being taken forward as a Health Technology Innovation Laboratory project.

We’ve also produced an evidence summary on the clinical and resource use impacts of using desflurane – a general anaesthetic agent with a significant global warming potential – compared with other agents in two populations. Our evidence summary informed NHS England’s desflurane decommissioning and clinical use guidance.

Further information on our work to support the environmental sustainability of the health and care system can be found on our environmental sustainability web page.

MHRA-NICE Effective Regulation and Evaluation of Digital Mental Health Technologies

We are collaborating with the MHRA on a Wellcome-funded project to explore issues around regulation and evaluation of digital mental health technologies. These technologies can range from diagnostic and monitoring tools, self-help CBT apps and websites, virtual reality and AI based therapies and prediction models.

There has been a large increase in the number of digital mental health technologies on the market in recent years. However, these products present challenges for regulation and health technology assessment, including whether technologies are medical devices, how they should be classified, and how evidence can be generated to support assessment of their effectiveness and cost-effectiveness.

Across 5 work packages, we are exploring the digital mental health landscape and considering issues around qualification and classification, clinical evaluation, and post-market surveillance and lifecycle assessment. At each stage, we are engaging with and learning from people with lived experience and other subject experts, as well as working with international partners to help drive shared learning and international consensus.

NICE Listens

NICE Listens is our programme of deliberative public engagement. It gives us an understanding of public opinion on moral, ethical and social value issues.

Using best practice methods, we work with external contractors who specialise in public engagement.

A new sample of members of the public is invited to take part in each project. They are given time to learn and become familiar with the topic area, before discussing it in detail and making recommendations. These recommendations are then be used by our executive team and board to inform various aspects of our work.

Find out more about NICE Listens.

Severity modifier

The severity modifier was introduced in 2022 in order to place greater value on health benefits provided for people with more severe diseases. Our review of decisions from technology appraisals published between January 2022 and March 2024 found that the severity modifier has been operating as intended. It has been applied to a wider range of diseases then the end of life modifier that it replaced and has resulted in a higher proportion of positive recommendations.

We’re continuing to monitor the use of the severity modifier to check that it remains opportunity cost neutral compared to the end of life modifier. We’re also progressing further research to understand in greater depth the extent to which society places additional value on treatments for severe diseases. 

Societal perspective

NICE methods guidance states that the default perspective for economic evaluations should be that of the NHS and personal social services, but a broader set of effects can be included in exceptional circumstances when they are deemed especially relevant and when requested by the Department of Health and Social Care in the remit for the evaluation.

We undertook an appraisal of policy options regarding the perspective of economic analyses conducted by NICE. The NICE Board supported our recommendation that NICE should retain its current approach to perspective.

We continue to engage with stakeholders on this important topic and have had a letter published in the British Medical Journal clarifying NICE’s approach.