OBJECTIVES: NICE introduced the severity modifier in February 2022 to reflect preferences for prioritizing treatment for severe diseases. We reviewed the application of the severity modifier in the 12-month period ending May 2024.

METHODS: We identified single technology appraisals (STAs) published between 01/06/2023 and 31/05/2024 and reviewed the associated committee papers and guidance documents. We extracted information on the patient population, and the manufacturer, external assessment group (EAG) and NICE committee positions on the severity modifier’s applicability.

RESULTS: Sixty-four appraisals met our search criteria; severity modifiers were discussed in 46 (72%). In the remaining appraisals, the manufacturer presented a cost-comparison analysis, or the submission preceded or followed shortly after the severity modifier’s introduction. Of the appraisals where the severity modifier was discussed, the manufacturer made a case for its application in 33% (15/46). The EAG agreed with the manufacturer in all but one appraisal (TA949). The 1.2 severity modifier was applied in 11 appraisals, with the 1.7 severity modifier applied in 5 appraisals. All but one of these appraisals were in oncology, with 43% in blood cancer. Reporting of severity modifier calculations was inconsistent, with manufacturers reporting calculations in all appraisals where a case for the severity modifier was made, and only 59% of appraisals where no case was made. The average baseline population age was lower in appraisals where a severity modifier was applied (43.0 vs 56.5).

CONCLUSIONS: In the 12-month period ending May 2024, a severity modifier was applied in 30% of eligible STAs. The higher severity modifier, which aligns most closely with the former end-of-life criteria, was applied in only 11% of eligible appraisals. Severity modifiers continue to be predominantly applied in cancer indications and in younger patient populations. More consistent reporting of severity modifier calculations is recommended to enhance transparency and comparability across appraisals.