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At yesterday's meeting (25th September 2024) our board concluded that the new severity modifier is working as intended.

The new modifier was introduced in 2022 to allow extra weight to be given to medicines that address severe diseases. It replaced a previous modifier that only allowed extra weight to be given for medicines to treat end-of-life conditions.

NICE has been monitoring the use of the severity modifier and presented a review to its Board. The review showed:

• Where the new severity weighting has been used there has been a higher proportion of positive recommendations (84.4%) compared with the end-of-life modifier (82.7%).
• The severity modifier has been applied to diseases including non-end-of-life cancers as well as non-cancer conditions that have dramatic and far-reaching impacts on patients, such as cystic fibrosis, which would not have qualified for additional weighting under the previous criteria.
• Medicines for late-stage cancers are being recommended following the change, including for colorectal, lung and breast cancers.
• The proportion of positive cancer recommendations is higher (80%) than with the end-of-life modifier (75%) and the proportion of positive recommendations for advanced cancer treatments is also higher (81% compared to 69%).

Dr Sam Roberts, chief executive of NICE, yesterday said:

The analysis shows the severity modifier is doing what it was designed to do. It has allowed treatments for a broader range of severe diseases to be recommended for patients on the NHS, such as cystic fibrosis and hepatitis D, as well as a range of non-end-of-life cancers. This is in line with the higher value society gives to the important benefits such treatments provide.

Up to the end of July 2024, 19 appraisals have involved the updated severity weighting. 16 (84%) have resulted in a positive recommendation, including 14 positive appraisals for blood, bowel, breast, endometrial, gastric and lung cancers.  

Use of the severity modifier has also seen positive recommendations for treatments for cystic fibrosis and chronic hepatitis – neither of which would have qualified for an additional weighting under the old system.  

The Board also agreed to continue monitoring the impact of the severity modifier's introduction. As part of that work, it will commission additional research into what society’s preferences are in terms of valuing medicines that treat severe diseases.