At the beginning of December 2025, the government announced that it intends to increase the thresholds that the National Institute for Health and Care Excellence (NICE) uses in evaluations of new medicines to decide which are cost-effective for use in the NHS. This was followed on the 9 December with the government launching a consultation on granting ministers a power to direct NICE on the standard cost-effectiveness threshold.
On its website NICE stated that the change, from April 2026, is designed to improve the operating environment for pharmaceutical companies in the UK to maximise the government’s commitment to unlock innovation and support the sector. It says:
“NICE ….welcomes the government’s support to use a new value set for valuing health-related quality of life. The value set comes from asking thousands of people from the public to judge how good or bad different health states would be… this change may additionally impact the cost-effectiveness of medicines”.
This is the first time in its 25-year history that NICE has been explicitly instructed by the government on its methods and changes to its cost-effectiveness threshold. Furthermore, NICE has only changed the description of its values on two previous occasions
The reaction to these announcements have been polarised, to say the least. On the one hand, it is seen as a necessary response to Trump’s foreign policy on pharmaceuticals and on the other that this is going to be highly damaging to the NHS and detrimental to public health. Health economists at the University of York estimate that applying this new threshold would result in 4,500 additional deaths and a loss of almost 120,000 years of life in good health each year. These changes mean far more than simply higher prices for drugs.
Of course, the call to increase the threshold is not new. The threshold has not changed in 25 years, and the pharmaceutical industry has been pushing for some time to increase it. Indeed, it is rumoured that NICE itself was receptive to a change and had suggested to the government some time ago that it would be minded to make the change.
However, the Department of Health and Social Care was not keen, presumably due to the cost implications. But the breakdown of negotiations between the government and the pharmaceutical industry on drug pricing and then the input by Trump to protect the USA pharmaceutical industry has led to a change in policy. This could have been done by just allowing NICE to proceed with what it had wanted to do. Instead, the government made the announcement that it would change the law to facilitate it dictating to NICE what the threshold should be.
What is the logic behind this? Well, presumably, the government want the credit for the threshold change and to signal that control rests with them on key health issues
This is a high-risk strategy as the main reason for the establishment of NICE was for it to take ‘the hit’ on difficult prioritisation decisions rather than government ministers. This protection is now lost. Furthermore, the trust that NICE has built over the last 25 years was based on its perceived independence and was seen as key to its survival. Even the Department of Health and Social Care has acknowledged this in its own risk assessment of the new policy.
What will happen next is unclear. Already it seems that these changes may fail to have their intended impact. Rather than investing in UK R&D capacity the pharmaceutical industry remain eager to relocate from the UK to USA and the inward investment promised from the USA seems to have stalled already.
In a recent HSJ article on this issue I described it as “the greatest threat yet to NICE’s existence,” and I encouraged people to respond to the consultation. During our NIHR ARC South London social values project we responded to a number of NICE-related consultations and we will do so again. I encourage you, whether as an individual or organisation, to respond too!
The consultation closes on the 13 January 2026 and takes the form of a short survey on the two proposals:
It’s important that your views are heard. Whether NICE will continue to flourish, or indeed survive, will depend on whether it can adapt to this new policy storm, perhaps based on constructive ideas that emerge from the consultation
This is not only a debate about NICE, but also about how the NHS and the UK’s public health system are going to be planned and managed in the future.