Medical Treatments

The National Institute for Health and Care Excellence (NICE) is responsible for the methods and processes that it uses in the development of its recommendations. The severity modifier was introduced in January 2022 as part of a number of changes intended to make NICE’s methods fairer, faster and more consistent.

The design of the NICE severity modifier was based on the principle of opportunity cost neutrality to ensure that introducing additional weighting for severe conditions did not increase overall National Health Service spending or displace more care than the previous end-of-life modifier. This approach protects the finite NHS budget by preventing inflationary effects on costs, ensuring that prioritising severe conditions does not reduce health benefits for other patients elsewhere in the system.

NICE carried out a review of the implementation of the severity modifier in September 2024 and found that it is operating as intended with a greater proportion of medicines recommended than under NICE’s previous methods. Since then, NICE has continued to monitor how the severity modifier is being applied. The latest figures include data from technology appraisals published up until the end of September 2025 and show that the proportion of positive decisions has increased since the severity modifier was implemented and since data was published in September 2024. 87.0% of decisions taken since the severity modifier was implemented, compared with 82.5% when the end-of-life modifier was being used.

NICE has commissioned research to gather further evidence on societal preferences that will inform future methods reviews.