Hesam Ghiasvand, Seyran Naghdi
The NICE threshold uplift was framed as a politically mediated reform with implications for industrial strategy, HTA governance, healthcare resource allocation, and public trust. The findings demonstrate how cost-effectiveness thresholds can become sites of broader political, economic, and institutional contestation, extending beyond their conventional role within health economic evaluation.
OBJECTIVES: To examine how governmental, industry, academic, consultancy, journalistic, and international health technology assessment (HTA) stakeholders framed the cost-effectiveness threshold (CET) uplift announced for the National Institute for Health and Care Excellence (NICE) in December 2025 during the early phase of policy debate.
METHODS: A qualitative documentary content analysis was conducted using the READ framework. Twenty-seven publicly available documents published between October 2025 and March 2026 were purposively sampled across government, NICE, industry, academia, consultancy, journalism, civil society, and international HTA actors. Data were analysed through iterative coding and thematic synthesis.
RESULTS: The 2025-2026 debate extended beyond technical discussions of cost-effectiveness and revealed five interrelated themes. First, government documents explicitly reframed the CET as an instrument of industrial policy, economic growth, and pharmaceutical competitiveness. Second, substantial disagreement emerged regarding HTA governance and ministerial involvement in threshold-setting. Third, stakeholders advanced competing interpretations of the consequences of the reform, with government and industry emphasising innovation access, while academic and public-interest sources highlighted opportunity costs, service displacement, and population-health impacts. Fourth, many documents situated the reform within broader geopolitical and pharmaceutical-policy dynamics, including trade negotiations, investment incentives, and potential international spillovers. Finally, stakeholders expressed contrasting views regarding transparency, consultation, and procedural legitimacy.
CONCLUSIONS: The NICE threshold uplift was framed as a politically mediated reform with implications for industrial strategy, HTA governance, healthcare resource allocation, and public trust. The findings demonstrate how cost-effectiveness thresholds can become sites of broader political, economic, and institutional contestation, extending beyond their conventional role within health economic evaluation.