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When NICE (the National Institute for Health and Care Excellence) recommends — or
declines to recommend — a new medicine or medical technology for use in the NHS, that
decision comes out of a formal, published process called technology appraisal.
For a research administrator, health economist, or clinical trial team preparing evidence for
one of these appraisals, understanding the mechanics of the process matters as much as
understanding the underlying health-economics concepts it runs on.
What technology appraisal guidance is
Technology appraisal (TA) guidance is NICE’s recommendation on whether a new or existing
medicine or other health technology should be used within the NHS, and if so, for which
patients and under what conditions. It sits alongside NICE’s other guidance types (clinical
guidelines, quality standards) but is distinct in one important way: TA recommendations on
NHS-funded medicines are backed by a statutory funding direction, meaning NHS bodies in England
are legally required to fund a technology NICE recommends, within a set timeframe, once
guidance is published.
Single technology appraisal vs. multiple technology appraisal
NICE runs two related but distinct appraisal routes:
- Single technology appraisal (STA). Used for a single product, typically
close to or shortly after its UK marketing authorisation, evaluated against a defined
comparator. This is the route most new medicines go through, and it follows a published
timeline from the manufacturer’s evidence submission through committee decision. - Multiple technology appraisal (MTA). Used when several competing
technologies for the same condition are evaluated together, or where NICE-commissioned
independent evidence review is judged more appropriate than manufacturer-led submission alone.
MTAs are less common than STAs but allow head-to-head comparison across more than one product
in a single appraisal.
Who is involved: evidence review groups and the appraisal committee
Two bodies do the substantive evidence work behind a TA decision. An independent
Evidence Review Group (ERG) — typically an academic health economics
unit under contract to NICE, not part of the manufacturer’s submission team — critiques
the clinical and economic evidence the manufacturer submits, checking the modelling
assumptions, the QALY and ICER calculations, and the plausibility of the comparator choice. The
appraisal committee, a standing multidisciplinary group including clinicians,
health economists, patient/carer representatives and NHS commissioners, then weighs the
manufacturer’s submission against the ERG’s critique and reaches a recommendation.
How cost-effectiveness is assessed
The economic case in a technology appraisal is built on the two concepts covered in depth in
CASRAI’s dictionary: the QALY
(the common health-outcome unit) and the ICER (the resulting
cost-per-QALY figure for the new technology versus the relevant comparator). The committee
weighs the submitted ICER against a cost-effectiveness threshold — NICE
has historically applied a range of £20,000 to £30,000 per QALY gained for most appraisals. In
December 2025 NICE confirmed it will move to a new range of £25,000 to £35,000 per QALY once it
has the power to apply it, following a change agreed at policy level; the exact date that
change took effect was not independently confirmed for this page, so a team preparing a live
submission should verify the current, applicable threshold directly on NICE’s own site rather
than relying on either figure here as current. The threshold is not applied as a rigid cutoff
in isolation — severity of the condition, quality of the evidence, and other explicit
modifiers can shift how a given ICER is judged, particularly for smaller patient populations
or more severe conditions where NICE applies a modified, more generous threshold range.
Reporting the underlying economic evaluation
Whatever a submission’s ICER and QALY figures turn out to be, they need to be reported to a
recognised methodology for an ERG and committee to be able to scrutinise them. CASRAI’s CHEERS 2022 checklist guide covers the current
standard for reporting an economic evaluation of this kind, and the broader context of health
economics as a field — funding, research areas, career paths into economic-evaluation work
— is covered in CASRAI’s What Is Health
Economics? guide.
Frequently asked questions
What is a NICE technology appraisal?
It is NICE’s formal process for deciding whether a new or existing medicine or health
technology should be recommended for use in the NHS, based on a structured review of its
clinical and cost-effectiveness evidence by an independent Evidence Review Group and a
standing appraisal committee.
Is a NICE technology appraisal recommendation binding on the NHS?
Where NICE issues positive TA guidance on an NHS-funded medicine, NHS bodies in England are
under a statutory funding direction to make that medicine available within a set timeframe —
this is a materially stronger obligation than NICE’s other guidance types carry.
What happens if a technology’s ICER is above the threshold?
A recommendation is not automatically negative — the committee can still recommend the
technology where severity modifiers or other explicit factors apply, or a company can offer a
confidential commercial arrangement (a price discount) that brings the effective cost, and
therefore the effective ICER, back within an acceptable range.
