For UK pharmaceutical and life sciences leaders
Your ICER sits above threshold and NICE has signalled rejection
A negative appraisal can lock you out of NHS market access for three to five years. Most products above NICE's £20,000 to £30,000 per QALY cost-effectiveness threshold are rejected unless a specific exception pathway is pursued, and few teams know how to build that case.
£20,000 to £30,000 per QALY cost-effectiveness threshold. Source: NICE
Two minutes. Solva follows up with specific exception and managed access pathway options.
- Product launch delays in the UK market
- Limited or no access to the NHS for innovative medicines
- Requirement for significant price reductions to meet cost-effectiveness thresholds
- Negative public perception and media coverage
- Diversion of resources to manage appeals or alternative market access pathways
- Morale impact on market access and medical affairs teams
- Significant revenue loss from inability to access the NHS market
- Increased R&D costs without corresponding return on investment
- Delayed patient access to innovative treatments
- Suboptimal patient outcomes due to lack of effective therapies
- Damage to company's reputation as an innovator
- Negative perception among healthcare professionals and patient groups
- The primary root cause is often a lack of early, integrated UK-specific market access strategy during product development.
- This leads to global evidence packages that do not adequately address NICE's unique cost-effectiveness thresholds and local clinical practice nuances.
- Furthermore, insufficient engagement with NICE and key UK stakeholders throughout the development process can result in critical evidence gaps and a failure to build a compelling value proposition tailored to the NHS context.
NICE has made positive recommendations (recommended, optimised, or recommended for the Cancer Drugs Fund) in 85% of its technology appraisals. (NICE, 2026)
How to fix it
A NICE strategy review covering the evidence package, the appropriate pathway, the comparator selection, and the managed access options produces a clear approach within two to three weeks.
Frequently asked questions
Why does this problem persist?
NICE applies a cost-effectiveness threshold of £20,000-£30,000 per QALY for most medicines. Products above this threshold face rejection unless they qualify for end-of-life, rare disease, or other special consideration pathways.
What is the cost of leaving it unaddressed?
A negative NICE appraisal can lead to significant revenue foregone due to delayed or denied market access to the NHS for 3-5 years. (Multiple sources, industry consensus)
This is exactly what I do with UK private practices. Answer the few questions above and I'll come back personally with where to start. Paul.