News
5 March
2026
Policy pantomime - The consultation that wasn't
The UK government’s Department for Health and Social Care recently published its response to a consultation regarding whether ministers should be able to influence the National Institute for Health and Care Excellence (NICE) on its cost-effectiveness threshold. Many of those that responded opposed the proposal: 57% opposed the core proposal, 53% opposed extending it to all NICE guidance, and 76% opposed removing the requirement for NICE to consult on methodological changes following a ministerial direction. Yet despite this overwhelming objection, the change is going ahead.
In a new Substack post, Professor Andrew Briggs and Francis Ruiz, Senior Policy Advisor at the London School of Hygiene & Tropical Medicine, argue that the consultation process was essentially performative rather than a genuine attempt to gather insight from key stakeholders. This includes those who would be directly impacted, such as patient groups and community care or prevention providers who risk having their funding slashed to account for the increase in pharmaceutical spending.
Unsurprisingly, a large proportion of those responding on behalf of businesses, such as pharmaceutical companies, agreed with the proposal. And it’s their side that the government appears to be on, stating that the cost-effectiveness threshold is ‘a matter of public policy’ – in other words, it’s a political choice.
But allowing ministers to dictate NICE’s threshold is not an appropriate way forward. In a previous post, Andrew and Francis proposed a centrally funded pharmaceutical budget with its own threshold that could sit alongside NHS budgets to minimise trade-offs. This alternative would enable NICE to appraise technologies while allowing the government to value pharmaceuticals at a higher level, separating technical assessment from political decisions. However, the consultation response makes the government’s position clear - the opinions of health economists, patients and the public appear to mean little, and the consequences of this change will be devastating. NICE will lose its independence, funding will be displaced, and health inequalities will increase.
11 Feb
2026
New population-level analysis of MASH burden in the US
New research published in PharmacoEconomics – Open presents a population-level burden-of-disease model for metabolic dysfunction-associated steatohepatitis (MASH) in the US.
MASH is defined by a build-up of fat in the liver and signs of inflammation and liver damage (fibrosis). Individuals with MASH may develop cirrhosis which can result in liver cancer and liver failure. It is considered a major threat to public health and one that is likely to increase with rising obesity and diabetes prevalence.
The model, which has been developed using US population-level data, reveals that mortality is a greater burden than morbidity for MASH. The analysis found that the burden of MASH is greater if the disease is acquired earlier in life. Individuals with MASH face a greater burden in certain decades depending upon the age they were when they acquired MASH. Those who contracted the disease under the age of 40 face the greatest burden in their 8th decade, from the ages of 70-79. Those who contracted MASH over the age of 40 are likely to experience the greatest burden during their 9th decade, between the ages of 80-89. The analysis also found that the MASH burden was higher for women compared to men as women on average live longer lives.
The research presents a disaggregation of burden by age, sex and into the relative contribution of morbidity and mortality. At the US-population level the greatest burden is expected to fall on MASH patients between the ages of 60-79. Overall, this results in approximately 19.34 million years of quality-adjusted life-expectancy lost across the lifetimes of the current US population.
The threat of MASH to US public health is growing, but this model has the potential to make a valuable contribution to population-level diagnostic and treatment strategies for the disease.
28 Jan
2026
Minimally Important Differences for EQ5D
Should we estimate minimally important differences (MIDs) for preference-weighted health-related quality of life measures like the EQ-5D?
In a new Substack post, Professor Andrew Briggs makes the case against the estimation of MIDs. He argues that they are unstable, variable and fundamentally flawed.
The post follows a recent publication in Value in Health co-authored by Briggs that claims that MIDs for health state values have “no legitimate basis”. The authors argue that it is time to abandon them.
An alternative perspective from Johnson and Al Sayah, also published in Value in Health, argues the opposite. Johnson and Al Sayah claim that MIDs do have a use, acting as interpretative aids for measurement scales. They call for better guidelines to improve MIDs. However, as Briggs and colleagues argue, preference-weighted measures already do incorporate value judgement. MIDs are therefore unnecessary and unhelpful.
The Substack post adds further weight to the argument that MIDs should no longer be used by highlighting how they make it difficult to determine who is benefitting from a treatment and by how much. This is a barrier to effective decision making. Briggs concludes his post with suggestions for alternative measures that may be more effective for those working with EQ-5D scores.
19 Dec
2025
After NICE's threshold rise... what now?
Should the UK Government create a branded pharmaceutical fund? That’s the question posed by Professor Andrew Briggs and Francis Ruiz, Senior Policy Advisor at the London School of Hygiene & Tropical Medicine, in their latest Substack post.
The post is the third in a series regarding NICE’s threshold for decision making. In the first post, Andrew and Francis argued that, after no change for more than 20 years, it was time for the existing NICE threshold of £20,000-30,000 per QALY to be recalibrated. They noted how several accommodations for specific drugs and technologies have altered the threshold with implications for transparency, equity and efficiency.
The second post responded to NICE’s confirmation in early December 2025 that the threshold would increase to £25,000-£35,000 from April 2026. In that post, Andrew and Francis discussed the impact this change will have – opportunity costs for the NHS and those already vulnerable as budget for vital services and programmes is sacrificed to pay for more expensive drugs.
In the third and latest post, Andrew and Francis advocate for a centrally funded branded pharmaceutical budget with its own threshold that could sit alongside NHS budgets to minimise these trade-offs. This would enable NICE to appraise technologies while allowing the UK Government to value pharmaceuticals at a higher level.
This move would be both logical and feasible, given that other pharmaceutical budgets already exist outside of NICE’s standard decision rules, such as the Innovative Medicines Fund. Crucially, it would increase transparency by making the political choice to use pharmaceutical spending as an instrument of industrial policy explicit, rather than attempting to shape the NICE threshold into something it is not technically designed to be.
But is the UK Government ready to make this choice? Or will they continue to adjust NICE’s threshold in the hope that technical changes will reconcile incompatible objectives?
3 Dec
2025
The £25,000 - £35,000 Answer
After 20 years, the National Institute for Health and Care Excellence (NICE) has finally confirmed an increase to its cost-effectiveness threshold. The range will shift from £20,000 - £30,000 per Quality-Adjusted Life Year (QALY) to £25,000 - £35,000 per QALY and will come into effect in April 2026. But what impact will this have? And for whom?
Professor Andrew Briggs and Francis Ruiz, Senior Policy Advisor at the London School of Hygiene & Tropical Medicine, discuss the implications of this proposed change in a new Substack post. It follows a recent post 'The £20,000 - £30,000 Question' that called for the explicit increase of the threshold to strengthen transparency, equity and efficiency.
In the new post, the authors argue that the threshold increase is a political move following a zero-tariff pharmaceuticals deal between the UK and the US that will result in the UK paying more for new branded medicines. The changes are estimated to cost an additional £3 billion per year but there is no published plan for how this will be funded and neither the Department of Health & Social Care nor the Treasury have agreed to meet this cost centrally. As a result, the additional cost could fall on the already stretched NHS. This could mean that budget for vital services and programmes in mental health or community care, for example, are sacrificed to pay for more expensive drugs.
But this does not have to be the case. The post calls for NICE decisions to be grounded in economics not politics, and outlines what needs to be done to ensure that this threshold increase does not have a detrimental impact on population health.
10 Nov
2025
Whole Health - ISPOR's ambitious turn toward a whole new world?
The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) announced its new Strategic Plan 2030 earlier this year. The plan places the concept of ‘Whole Health’ at its centre, recognising “its potential to improve the wellbeing of people across the globe” – but what does this mean for health economics and outcomes research?
The concept of Whole Health acknowledges the multiple determinants and dimensions of health. In a new Substack post, Professor Briggs argues that existing discourse on Whole Health largely neglects environmental considerations, despite their significance for health and wellbeing. He states that interventions addressing the links between the climate and health, such as those focused on air quality, typically fall outside the scope of traditional health economics and outcomes research, and there is a notable lack of structures and frameworks for incorporating environmental determinants into value assessment. Professor Briggs further highlights that a Whole Health approach should recognise the impact of conflicts and humanitarian crises too.
But this prompts the question, can organisations such as ISPOR address these pressing issues if they are constrained by disciplinary boundaries and values of neutrality? Is this shift to a Whole Health perspective “an expansion of scope, a redefinition of value, or a mission stretch too far?” Ahead of the ISPOR Europe 2025 meeting in Glasgow, the post offers an insightful reflection on this ambitious new approach.
6 Nov
2025
The £20,000 to £30,000 question
Is it time to recalibrate NICE’s threshold for decision making? That’s the question posed in the latest ‘of QALYs & Quandaries’ Substack post, co-authored by Professor Andrew Briggs and Francis Ruiz, Senior Policy Advisor at the London School of Hygiene & Tropical Medicine.
In the early 2000s, the National Institute for Health and Care Excellence (NICE), revealed that its approach to economic evaluation is guided by a threshold range, where health technologies below £20,000 per quality-adjusted life year (QALY) may be considered cost-effective, while those above £30,000 per QALY are unlikely to gain approval. This threshold has not changed in over two decades.
Or has it? In the post, Andrew and Francis share insight into how the threshold is applied in practice, including how several accommodations for specific drugs and technologies have altered the threshold over the years. They highlight the implications this has for transparency, equity and efficiency before arguing for recalibrating the threshold and providing possible approaches.
The post concludes for a call for the intentional evolution of the NICE threshold.
19 Oct 2025
A 10-Year Review of NICE Appraisals of Oncology Combination Therapies
Higher termination rates and survival trade-offs
A study that aimed to quantify the proportion of oncology therapies terminated during the Health Technology Assessment (HTA) appraisal process in England was presented at the European Society for Medical Oncology (ESMO) in Berlin, Germany, on 19 October. The study reviewed 376 NICE oncology technology appraisals over a decade from 1 April 2014 – 31 March 2024 and found that combination therapies face a higher termination risk compared to non-combination therapies.
Comparative overall survival data between combination and standard of care were available for seven terminated combination appraisals. These were assessed to estimate potential survival gains lost revealing that the seven terminated combination therapies had positive survival data for patients but included components that bordered or exceeded NICE’s cost-effectiveness thresholds. This indicates that termination may be due to cost rather than poor clinical efficacy.
A poster, co-authored by Professor Andrew Briggs, summarised the findings and called for further investigations into the barriers to combination therapies. The poster, titled ‘Higher Termination Rates and Survival Trade-offs: A 10-Year Review of NICE Appraisals of Oncology Combination Therapies’, was presented at the ESMO Congress by co-author Vijay Joish. The congress offered a valuable opportunity to discuss current practices and the future of oncology research with leading experts.
22 Sept 2025
Composite Endpoints in Health Techonology Assessment
How can composite endpoints be used effectively in HTA?
A new two-part series of papers on composite endpoints in health technology assessment (HTA) has been published in the Journal of Comparative Effectiveness Research. The papers, co-authored by Professor Andrew Briggs, offer valuable guidance for those employing composite endpoints within cost-effectiveness models for HTA.
The first paper summarises guidance and introduces a framework for best practices in modeling trials with composite endpoints. The authors critically examine the advantages and risks associated with their use through a case study of dapagliflozin for heart failure. They then discuss how to develop and interpret modeling scenarios for HTA, highlighting the need to accurately capture the uncertainty of evidence used for decision-making.
The second paper expands the framework to consider how additional evidence from other drugs used to treat the same or similar conditions, or the same drug used to treat different conditions, could be used within HTA evaluations to increase their accuracy. The authors use the same case study of dapagliflozin for heart failure and introduce methods of including composite endpoint data in economic analyses.
Together the papers are a useful resource for those wanting to learn more about the appropriate and effective use of composite endpoints in HTA. The papers are also discussed in detail in an accompanying Substack blog written by Andrew Briggs.
21 July 2025
Sustainability in Health Technology Assessment
How can Health Technology Assessment (HTA) integrate environmental sustainability?
On 21 July, Professor Andrew Briggs delivered a presentation at the at the International Health Economics Association (IHEA) 2025 Congress in Bali, Indonesia titled 'How should health economic evaluations support sustainability considerations?'
The presentation began by defining sustainability, with reference to the Brundtland Report of 1987, that focused on global intergenerational equity and the integration of economic growth, social inclusion and environmental protection. Briggs then went on to discuss the recent International Network of Agencies for HTA (INAHTA) White Paper which refers only to environmental impact despite including sustainability in its title. Briggs then presented a framework for defining sustainability in HTA going forward.
This framework is discussed in detail in a new blog, available to read on Substack. In the blog, Briggs calls for the responsible embedding of sustainability into HTA, warning that tokenistic efforts to include environmental considerations, such as in the recent INAHTA White Paper, do not properly define or operationalise sustainability and fail to critically reflect on important questions such as:
- Who bears the environmental cost of technology production?
- Who is left out of adaptation strategies?
- Whose baseline emissions are considered “normal”?
Briggs argues that "Sustainability as it relates to health economics and HTA, properly understood, is not just about environmental impact. If HTA is to serve future populations—not just current decision-makers—it must begin by asking who counts, who pays, and who is left behind."
14 May 2025
Greening HTA?
Do we need to rethink our approach to value in the Anthropocene?
On 14 May, Professor Andrew Briggs delivered a presentation at the at the 2025 ISPOR meeting in Montreal on greening Health Technology Assessment (HTA). The ISPOR conference theme, ‘Collaborating to Improve Healthcare Decision Making for All: Expanding HEOR Horizons’, intended to underscore the vital role of health economics and outcomes research (HEOR) in transforming healthcare systems.
In his presentation, Andrew proposed things that may help or hinder the move to greener HTA methods. Helpful suggestions included better estimates of the Social Cost of Carbon; discount rates that don’t undervalue the next generation; and equity analyses that recognise the burden of climate change. Unhelpful approaches included Multi-Criteria Decision Analysis with health service decision makers and / or public; Life-Cycle Analysis layered onto HTA; and Incremental Carbon Footprint Effectiveness Ratios and Incremental Carbon Footprint Cost Ratios.
The presentation concluded with a warning that attempts to green HTA may in fact “exacerbate the very issues we aim to resolve” and to avoid this we must approach this move with humility and not haste. Andrew's recent post on his blog 'of QALYs & Quandaries' provides more detail on his presentation.
18 Apr 2025
Value Attribution in Combination Therapies
Pricing combination products: not how but who?
As combination therapies - especially in oncology - become more commonplace, payers and HTA bodies are struggling to price them fairly. Despite technical progress in methods to attribute value between component treatments, the key question remains: who should implement these solutions?
This editorial calls for a shift in focus from the technical to the institutional and procedural challenge. The authors argue that payers and their agents can no longer remain passive. Instead, they must actively own the value attribution process if we are to incentivise innovation without undermining budgetary sustainability.
Key themes include:
- Why “do nothing”, arbitrary pricing rules, or deferring to companies and competition law are all inadequate.
- The risks of underdeveloping promising add-ons due to distorted incentives.
- The case for HTA bodies to facilitate fair value-sharing in combination therapies.
This is a timely and essential read for anyone involved in health technology assessment, pharmaceutical pricing, or health system innovation.
31 Mar 2025
Cost-effectiveness analysis for Daridorexant in chronic Insomnia disorder
Let’s be honest - there’s comfort in orthodoxy. Health technology assessment (HTA) is built on a foundation of tried-and-tested conventions: lifetime horizons, a 'reference case' untainted by productivity, and a good old-fashioned faith in 'intention to treat' (ITT) analysis corrected by placebo control. But occasionally, a study comes along that quietly taps HTA on the shoulder and says, “What if we did things a bit differently?” We’ve just published a piece that does exactly that. It doesn’t blow up the methodological playbook - but it does underline the fact that the rules we follow are sometimes more a matter of habit than of logic.
Here are four ways the analysis dares to diverge:
1. A 12-Month Time Horizon Isn’t Heresy
We’re all conditioned to think that a “proper” economic evaluation must stretch to full patient lifetimes - especially for chronic conditions/treatments. But what if a lifetime perspective is not only unnecessary, but actively unhelpful?
In this case, we opted for a 12-month time horizon, and no, it wasn’t because we were trying to pull the wool over anyone's eyes, quite the opposite in fact. It was because the relevant costs and effects really do materialise within a year. This is particularly true for interventions with a short-term mechanism of action like daridorexant, that has a half-life around 8-hours. To get it's therapeutic effect you need to take it every day and that is clear from the clinical results. The clinical studies are a three month phase III registration study and a 40 week extension study. Hence we opted for a 12-month time horizon - sure we can model beyond that time period, but uncertainty explodes beyond the window of the observed data. When the future is murky and the present is policy-relevant, the “short-run” can offer the most meaningful long-term insight.
2. Placebo Correction - Handle With Care
It’s a familiar refrain: “Subtract the placebo effect to find the real treatment impact.” But this assumes that placebo responses are neatly separable, predictable, and static - like they’ve been pre-measured in a Petri dish.
Our approach leans into the idea that placebo responses are part of the real-world effect. If patients improve because they believe they’re being treated, does that not matter? The temptation to surgically remove the placebo effect often leads to assumptions about uniformity and persistence that don’t hold in practice. Our approach argued that after three months, any remaining improvements were not due to increasing efficacy (via a mechanism for which there is no biological basis) but rather due to selective attrition. Since placebo patients would receive no treatment in real-life we aregue that placebo correction beyond three months was not appropriate. A controversial idea for a community indoctrinated into 'evidence based medicine' and ITT analyses.
3. Selective Attrition Isn’t Just Noise
Missing data is annoying. Selective attrition is more than that—it’s a structural bias hiding in plain sight. If certain types of patients are more likely to drop out, and if that dropout correlates with treatment or outcome, then your ITT estimates start to wobble.
We tackled selective attrition as a methodological challenge, not a nuisance. Accounting for attrition selectively, revealed a very different narrative about the intervention’s cost-effectiveness. It turns out, who sticks around in your study can tell you much about the outcomes those subjects experience.
4. Productivity Gains: the thorn in the side of the 'Reference Case'
Productivity gains in HTA are a bit like carbs in a trendy diet: everyone pretends they don’t matter, but most secretly think they do.
Yes, the reference case says productivity should be excluded (at least in the UK). But in many real-world scenarios - especially those affecting working-age populations - the ability to function at work is a major benefit. We included productivity impacts not as an act of rebellion, but as an act of realism. If the intervention helps people get back to work, that’s an economic benefit, not an nuisance and certainly should not be ignored when decision-making for populations.
The Bottom Line
Methodology is never neutral. Every assumption—about time, bias, comparators, or value - shapes the story we tell about a technology. This study doesn’t claim to overthrow the HTA establishment. But it does ask a few uncomfortable questions, and maybe that’s exactly what HTA needs.
So if you’re tired of evaluations that follow the rules but miss the point, come take a look. Sometimes, breaking the mould is the most methodologically sound thing you can do.
28 Jan 2025
Andrew Briggs awarded the 2024 OHE Policy Innovation Prize
From Delaware to California:
A Road Map For Incentivising Environmentally Sustainable Innovation
Andrew Briggs, Professor of Health Economics at the London School of Hygiene & Tropical Medicine (LSHTM) and Principal Health Economist at Occam Research, has won the 2024 Office of Health Economics (OHE) Innovation Policy Prize. He shares the prize with Thomas Pogge, Professor of Philosophy and International Affairs at Yale University.
In 2024, the £40,000 Innovation Policy Prize focused on climate change and health and applicants were asked to address the following question:
“How can economic policies incentivise environmentally sustainable innovation in the life sciences sector?”
Professor Briggs was awarded the prize for his submission ‘From Delaware to California: A Road Map For Incentivising Environmentally Sustainable Innovation’. The roadmap detailed a three-pronged approach to incentivising innovation in the life sciences sector:
- To move from an ex-post to ex-ante incorporation of environmental externalities.
- To use a more inclusive definition of the social cost of carbon in valuing externalities.
- Create a fund based on health improvements generated by new products in a given jurisdiction to support inward investment in the life science industry in that jurisdiction as well as outward investment to support essential health services in lower income countries.
10 Jan 2025
Value Attribution in Combination Therapies
Common Ground and the Next Frontier
Introduction
The increasing use of combination therapies, particularly in oncology, has brought substantial benefits to patients but also significant complexities for health technology assessment (HTA). One of the most pressing challenges is the attribution of value—and consequently pricing—to individual components of combination treatments, especially when they originate from different manufacturers.
Two Proposed Solutions, One Common Objective
In the January 2025 issue of Value in Health, two frameworks were independently proposed to address the value attribution challenge:
- Attribution of Value Framework for Combination Treatments
- Outcome-Based Value Attribution Framework
While at first glance these frameworks may appear distinct, a deeper analysis reveals that their similarities significantly outweigh their differences. Both approaches share the fundamental objective of systematically attributing value between components based on clear and transparent principles, ensuring fair pricing and equitable access to effective therapies.
Common elements include:
- Emphasis on clear and transparent criteria for value distribution.
- Use of quantitative health outcomes (e.g., QALYs) as a neutral metric for attribution.
- Recognition of the critical importance of cooperation between stakeholders.
These similarities suggest a convergence in thinking among HTA researchers, highlighting a robust consensus on foundational principles.
Editorial Insights and the Real-World Implementation Challenge
The accompanying editorial by Oriana Ciani and Claudio Jommi [link to editorial] further underscores that the core theoretical issue of value attribution may now be effectively resolved. They stress that the most significant remaining challenge lies not in conceptual disagreements, but rather in practical implementation.
HTA bodies must now lead efforts to address the implementation hurdles. These include:
- Developing standardised guidelines for negotiations between manufacturers.
- Ensuring consistent application of frameworks across different treatment contexts.
- Facilitating collaborative data-sharing practices that underpin effective attribution.
A Call to Action for HTA Bodies
With the theoretical basis now solidified by two independently developed yet remarkably aligned frameworks, it is incumbent upon HTA bodies and policymakers to step forward. Solving practical issues around implementation is crucial to ensuring that the potential benefits of these frameworks translate into real-world outcomes, ultimately improving patient access to innovative combination therapies.
Conclusion
The convergence in approaches to value attribution for combination therapies marks significant progress. Now, addressing practical implementation challenges must become a priority. Collaborative efforts by HTA bodies, industry, and policymakers will be vital to overcoming these final hurdles and delivering equitable, effective treatments to patients.