Analysis of NICE's Severity Modifier in Appraisals

This technical report examines the application of NICE's severity modifier over a 12-month period ending in May 2024. It details that a severity modifier was applied in 30% of eligible single technology appraisals, with a higher modifier of x1.7 used in 11% of cases, primarily for cancer treatments. The report outlines the introduction of the severity modifier in February 2022, which replaced the previous end-of-life criteria, and describes the criteria for its application based on quality of life and life expectancy. The findings indicate that the severity modifier was predominantly used in oncology, with a significant portion of appraisals receiving positive recommendations. The report also highlights inconsistencies in the reporting of QALY shortfall calculations, which affects transparency across appraisals. Additionally, it notes the NICE Board's conclusion that the severity modifier is functioning as intended, while also indicating the need for further research to understand societal preferences regarding severe disease treatments.