The new UK EQ-5D-5L value set at NICE: what PMG51 means for utilities, ICERs, severity and evidence planning

Why the value set matters

Every QALY in a NICE cost-utility model passes through a value set: the model that converts EQ-5D questionnaire responses into utility values.^{[1, 2]} For adults, NICE has until now relied on the UK EQ-5D-3L value set, estimated from fieldwork in the UK population in 1993.^[3] On 27 August 2026, NICE published an interim methods statement (PMG51) making the EQ-5D-5L descriptive system and the new UK 5L value set its preferred approaches to measuring and valuing health-related quality of life in adults.^{[1, 2]} The statement covers technology appraisal and highly specialised technologies (HST) submissions, HealthTech evaluations and NICE guidelines, and it replaces NICE's position statement on the EQ-5D-5L value set for England (ECD16).^[1]

A new value set is more than a new scoring file. It changes the distance between health states, so it changes incremental QALYs and ICERs. It also changes the general population utilities that feed the severity modifier. NICE is explicit that 5L and 3L utilities are not comparable, in the same way that EQ-5D values are not comparable with SF-6D or HUI values.^[4]

From the 2017 position statement to PMG51

NICE first published its position statement on the 5L value set for England in November 2017 and updated it in October 2019.^[5] Independent quality assurance and reports from four independent experts raised concerns about the data and modelling in the English valuation study by Devlin et al. (2018), and NICE chose not to use that value set.^[5]

The 2019 statement kept the 3L value set for the reference case. Data collected with the 5L descriptive system were mapped onto the 3L value set, initially using the van Hout et al. (2012) mapping function, and NICE supported continued use of the 5L descriptive system in prospective studies.^[5] The PMG36 manual, published in 2022, then specified the mapping function developed by the Decision Support Unit (DSU), using the EEPRU dataset, for reference-case analyses.^[6]

In parallel, EuroQol and NICE announced on 24 October 2019 that a new 5L valuation study would be undertaken in the UK. EuroQol funded and managed it, with NICE, the Department of Health and Social Care and NHS England advising.^[7]

1. Nov 2017Position statementNICE publishes ECD16 on the 5L value set for England
2. Oct 2019Statement updatedNew UK valuation study announced with EuroQol
3. 2022PMG36 manual5L data mapped to 3L using the DSU function
4. Jan to Sep 2023Fieldwork1,200 interviews across the four UK nations
5. 15 Apr to 27 May 2026ConsultationModular update GID-NGC10027
6. 28 Apr 2026Value set publishedRowen et al., Value in Health 29(5), online
7. 27 Aug 2026PMG515L value set becomes NICE's preferred approach

Sources: NICE ECD16 and PMG51; EuroQol; Rowen et al. 2026.

The UK valuation study

The study was led by Professor Donna Rowen of the University of Sheffield as principal investigator, with co-investigators from universities and research groups across the UK.^[7] It was overseen by a Steering Group that included academic experts and representatives from NICE, the Department of Health and Social Care, NHS England and EuroQol, and an independent Quality Control team reviewed data quality throughout.^{[7, 8]}

Between January and September 2023, the team conducted 1,200 interviews with UK adults. The sample was representative for age, sex, ethnicity and socioeconomic group, and proportionally representative of England, Scotland, Wales and Northern Ireland. Of the interviews, 1,102 (91.8%) were by videoconference and 98 (8.2%) in person.^[9] Participants valued 102 health states using the composite time trade-off. The value set was generated with a random effects Tobit model.^[9] The Steering Group concluded that the final dataset was of acceptable quality and addressed the concerns raised in the quality assurance of the earlier value set for England.^[7] The value set was published online in Value in Health on 28 April 2026, in the May 2026 issue.^[9]

1,200interviews with a representative sample of UK adults

102health states valued by composite time trade-off

3,125EQ-5D-5L health states with a utility value

-0.567value of the worst state (55555)

Sources: Rowen et al. 2026; Navega Biz et al. 2026.

What PMG51 requires

The UK 5L value set should be used to derive all utility values for adults in reference-case analyses.^[2] The updated manual text names the EQ-5D-5L as the preferred measure in the reference case.^[6]

• 5L data: Where 5L responses are available, they should be valued directly with the UK value set. EuroQol provides scoring syntax for Excel, SPSS, R, SAS and Stata.^{[4, 8]} Historic 5L data that were previously mapped to 3L can be valued directly in a re-analysis. NICE does not expect further 5L data collection to align with the updated manual.^[4]
• 3L data: 3L data, from trials or the literature, should be mapped to 5L utilities using the DSU and EEPRU mapping model (Hernández Alava et al. 2023).^[2] This is a response mapping model, so the underlying statistical model is unchanged; only the second, valuation step has been updated to the new value set. The DSU's Stata, Excel and R commands reflect this.^{[4, 10]}
• Mean utilities without patient-level data: Aggregate 3L values can be mapped directly using a bandwidth parameter: 0.1 for 3L values from 1 to 0.6 inclusive, and 0.4 for values below 0.6.^[4]
• Non-EQ-5D measures: The mapping model must be fully described, justified and shown to fit the data, with sensitivity analyses across models. Where no model maps directly to 5L, a measure may be mapped to 3L first and then to 5L.^[2] NICE notes that tools to reflect parameter uncertainty in the 3L to 5L step in probabilistic sensitivity analysis are not currently available.^[4]
• Departures from the reference case: Mapped 3L data, literature values and mapped non-EQ-5D measures are all treated as departures from the reference case.^[6]
• No 3L scenarios: Utilities from the 3L value set should not be included in sensitivity or scenario analyses.^[2]
• General population utilities: The 5L value set is also used for general population health-related quality of life, including the utilities behind absolute and proportional QALY shortfall.^[2]

The technical FAQ adds practical detail. Non-UK 5L value sets are not preferred over mapping UK 3L values, because value sets are country-specific.^[4] Published 3L disutilities should be anchored to an absolute state before mapping, because mapping works on absolute values rather than decrements.^[4] Carer utilities based on 3L should be mapped to 5L, bolt-on dimensions are not part of the reference case, and NICE does not recommend specific measures for children.^{[2, 4]} The evidence needed to show that the EQ-5D is not appropriate is unchanged.^[2]

1. 5L responses in a relevant studyScore directly with the UK value set
2. 3L responsesMap with the DSU and EEPRU response mapping model
3. 3L mean values onlyMap with the bandwidth rule (0.1 or 0.4)
4. Non-EQ-5D measureJustified mapping model, double mapping via 3L if needed

• Reference case5L utilities from patient-reported 5L data
• Departure, justifiedMapped or literature values with sensitivity analyses
• Not used3L-valued utilities, including in scenarios

Source: NICE PMG51, statement, appendix A and appendix C.

How the 5L value set differs from 3L

The two value sets have a similar floor. The worst 5L state is valued at -0.567, against -0.594 for the worst 3L state.^[9] Only 14.8% of 5L states are valued below zero, compared with 34.6% for 3L, and the mildest impaired state is valued at 0.968 under 5L against 0.883 under 3L.^[9] Across all health states, the 5L value set has a mean of 0.322 against 0.137 for 3L, and it is left-skewed where the 3L is right-skewed.^[3] Part of that 3L shape comes from the N3 term, a decrement of 0.269 that applies to 211 of the 243 3L states.^[3]

Anxiety/depression and usual activities have a greater relative impact on utilities than in the UK 3L value set.^[9] And the relationship between the two systems is not monotonic: a move that raises utility under 3L does not always raise it under 5L.^[3]

UK EQ-5D-3L value set

• 243 health states
• Worst state -0.594
• 34.6% of states below zero
• Mildest impaired state 0.883
• Mean across states 0.137, right-skewed

UK EQ-5D-5L value set (2026)

• 3,125 health states
• Worst state -0.567
• 14.8% of states below zero
• Mildest impaired state 0.968
• Mean across states 0.322, left-skewed

Sources: Rowen et al. 2026; Navega Biz et al. 2026.

Models use mean utilities rather than raw states. Navega Biz and colleagues mapped the utility values from 39 NICE appraisal decisions to 5L. Values rose in almost all cases, and the increase was larger for lower, more severe starting 3L values, with a few exceptions where the 3L value was very high.^[3] The authors describe the overall effect as shifting values towards the top of the scale and compressing them into a smaller range.^[3] General population values follow the same pattern: 5L utilities are higher than 3L at all ages, and the gap widens with age and is larger for women.^[11]

What it means for incremental QALYs and ICERs

The mechanism is easiest to see by splitting a QALY gain into two parts:

Incremental QALYs = (comparator utility x life years gained) + (treatment-arm life years x utility gain)

When the value set lifts mean utilities, the first term grows: each additional year of life is worth more. When it compresses the distance between states, the second term shrinks: each step up in quality of life is worth less. We would therefore expect technologies whose benefit is mainly survival to gain QALYs under 5L, and technologies whose benefit is mainly quality of life to lose them, with mixed results in between.

The published evidence supports this. Across 39 appraisal decisions from 37 technology appraisals published between 2016 and August 2024, the authors mapped all utilities to 5L and left other inputs unchanged.^[3] In the 17 oncology decisions, incremental QALYs increased (mean 12.5%) and ICERs decreased (mean 11.1%). In the 11 non-oncology decisions without a survival gain, incremental QALYs decreased in every case (mean 37.5%) and ICERs increased (mean 61.4%). Results were mixed in the 11 non-oncology decisions with a survival gain, with incremental QALYs rising in 7.^[3] The authors note that the case studies are not necessarily representative of the whole programme.^[3]

• Oncology (n=17): incremental QALYs, increase12.5%
• Oncology (n=17): ICER, decrease11.1%
• Non-oncology, no survival gain (n=11): incremental QALYs, decrease37.5%
• Non-oncology, no survival gain (n=11): ICER, increase61.4%

Mean absolute change. Source: Navega Biz et al., Value in Health 2026.

A worked example

The table below is illustrative. The 3L and 5L utilities are hypothetical values chosen to mirror the direction of change described above. They are not outputs of the DSU mapping model, and discounting is ignored for clarity.

In the example, one ICER rises by half and the other falls by about a fifth. Real models combine both effects, so the net effect has to be calculated, not assumed. For how these ICERs sit against the current decision range, see our guide to NICE technology appraisal in 2026.

The severity modifier on the 5L basis

PMG51 requires absolute and proportional QALY shortfall to be calculated using 5L utilities and 5L population norms. The severity cut-offs are unchanged.^[4] A QALY weight of 1.2 applies at a proportional shortfall of 0.85 to 0.95 or an absolute shortfall of 12 to 18, and 1.7 at 0.95 or 18 and above, whichever measure implies greater severity.^[12] The modifier applies in technology appraisals; no additional severity weighting is applied in HST evaluations.^[12] Our article on the NICE severity modifier covers the calculation in full.

Both sides of the shortfall calculation move. Absolute shortfall is general population QALYs minus expected QALYs with current care, and proportional shortfall divides that difference by general population QALYs.^[12] Under 5L the general population figure rises: the DSU estimates the increase in discounted quality-adjusted life expectancy at 0.46 to 0.94 QALYs for women and 0.33 to 0.63 for men, depending on age.^[11] Comparator-arm QALYs also tend to rise, because mapped utilities increase most for severe starting values.^[3] We would therefore not expect the net effect on shortfall to be predictable in advance.

The DSU impact study tested this in 39 appraisal decisions, with a further 18 in a more severe sensitivity sample.^[11] In the main sample, only one decision would move severity category, from 1.7 to 1.2. Mean proportional shortfall fell from 0.59 to 0.55 and mean absolute shortfall from 8.02 to 7.73.^[11] All oncology appraisals had higher absolute shortfall (mean increase 0.55 QALYs). Non-oncology results varied more, with the largest reduction in absolute shortfall at 3.8 QALYs and larger reductions at younger modelled starting ages.^[11] The authors conclude that the move is unlikely to have a significant effect on use of the modifier across the programme, but that individual technologies, most likely outside oncology, may occasionally be substantially affected.^[11] NICE will continue to monitor the mean QALY weight across appraisals, and research on societal preferences for severity is ongoing.^[4]

The 5L value set changes the comparator arm and the general population at the same time. For most topics the severity weight will hold, but for a younger, non-oncology population close to a cut-off, the shortfall should be recalculated on the 5L basis before any pricing conversation starts.

Transition rules and what is still to come

NICE is applying the change prospectively, in line with its modular updates framework.^[13]

• Technology appraisals and HST: The 5L value set must be used for any topic with an invitation to participate issued after PMG51 was published.^[13]
• HealthTech and guidelines: It applies to HealthTech topics launched, and guideline topics selected, after publication.^[13]
• Ongoing topics: Topics started before publication continue to map 5L data to 3L utility values.^[13]
• Published guidance: Guidance will not routinely be reviewed solely to incorporate the 5L value set. A review is considered only where new evidence, system changes or other information would have a material effect on the recommendations.^[13]

NICE consulted on the modular update between 15 April and 27 May 2026, and the updated manuals, a summary of consultation comments and NICE's responses will be published later this year.^{[14, 15]} As of 1 November 2026, the project page for the modular update (GID-NGC10027) lists the expected publication date as to be confirmed.^[16] NICE is also running an impact assessment on a few non-cancer guidelines, for information only, and may update the technical FAQ as new questions arise.^[15]

Our view

The invitation to participate date is the practical trigger. For a topic that may be scheduled close to or after 27 August 2026, we would plan the utility analysis on the 5L basis from the outset, and confirm the basis early with NICE for any review or re-appraisal.

Scotland, Wales and Ireland

The table summarises what each body's current published guidance says, as of 1 November 2026.

In our experience, the practical consequence is that a single UK model may need more than one utility basis. Where AWTTC's published guidance still refers to the 3L value set, we would recommend confirming the expected basis with AWTTC before submission. Our pages on SMC submissions and NCPE submissions cover the wider requirements, and our model adaptation work covers building these variants into one model.

What this means for evidence planning

In our view, PMG51 favours evidence that reaches the 5L value set with as few steps as possible. Direct 5L data are the preferred source. Mapping, and double mapping in particular, brings additional uncertainty that committees consider within the full evidence base.^[4]

• Collect EQ-5D-5L in pivotal trialsPatient-reported 5L data, valued directly, are the reference case
• Re-score historic 5L dataData previously mapped to 3L can be valued directly with the UK value set
• Plan mapping for every 3L inputTrial, literature, adverse event and carer values all move to 5L
• Record the instrument behind literature valuesUpdate SLR extraction so the value set of each source is captured
• Anchor disutilities to absolute statesMapping works on absolute values, not decrements
• Justify any non-EQ-5D mappingDescribe fit and test alternative models in sensitivity analyses
• Re-run severity on the 5L basisUse 5L norms and the updated DSU calculators
• Set out the utility basis by countryAlign NICE, SMC, AWMSG and NCPE requirements early

Global models built on international value sets need particular care, because NICE does not prefer non-UK 5L value sets over mapped UK values.^[4] For systematic reviews of utilities, extraction forms should capture the instrument, the value set and the population mean for each source, so that values can be mapped correctly later.

Evidaxia supports companies with utility evidence, economic models and NICE submissions under the new value set. Find out more about our health economic modelling, systematic literature reviews and NICE technology appraisal services, or contact us to discuss a specific topic.

References

1. National Institute for Health and Care Excellence. Interim methods statement: implementing the EQ-5D-5L value set (PMG51). Overview [Internet]. London: National Institute for Health and Care Excellence; 2026 Aug 27 [cited 2026 Nov 1]. Available from: https://www.nice.org.uk/process/pmg51
2. National Institute for Health and Care Excellence. Interim methods statement: implementing the EQ-5D-5L value set (PMG51). Statement on using the EQ-5D-5L value set [Internet]. London: National Institute for Health and Care Excellence; 2026 Aug 27 [cited 2026 Nov 1]. Available from: https://www.nice.org.uk/process/pmg51/chapter/statement-on-using-the-eq-5d-5l-value-set
3. Navega Biz A, Hernández Alava M, Wailoo A. Switching from EQ-5D-3L to EQ-5D-5L in England: the impact in NICE technology appraisals. Value Health. 2026;29(5):794-801. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC13215771/
4. National Institute for Health and Care Excellence. Interim methods statement: implementing the EQ-5D-5L value set (PMG51). Appendix C: technical frequently asked questions [Internet]. London: National Institute for Health and Care Excellence; 2026 Aug 27 [cited 2026 Nov 1]. Available from: https://www.nice.org.uk/process/pmg51/chapter/appendix-c-technical-frequently-asked-questions-faqs
5. National Institute for Health and Care Excellence. Use of the EQ-5D-5L value set for England: NICE position statement (ECD16) [Internet]. London: NICE; 2017 Nov 2 [updated 2019 Oct 31; cited 2026 Nov 1]. Superseded by PMG51. Available from: https://www.nice.org.uk/process/pmg51/resources/position-statement-on-the-use-of-eq5d5l-superseded-october-2019-pdf-15796940077
6. National Institute for Health and Care Excellence. Interim methods statement: implementing the EQ-5D-5L value set (PMG51). Appendix A: changes to NICE manuals [Internet]. London: National Institute for Health and Care Excellence; 2026 Aug 27 [cited 2026 Nov 1]. Available from: https://www.nice.org.uk/process/pmg51/chapter/appendix-a-changes-to-nice-manuals
7. EuroQol Research Foundation. Notes for users from the UK: new UK EQ-5D-5L valuation study [Internet]. Rotterdam: EuroQol Research Foundation; [date unknown] [updated 2025 Jan; cited 2026 Nov 1]. Available from: https://euroqol.org/information-and-support/user-support/uk-eq-5d-5l-valuation-study/
8. EuroQol Research Foundation. Scoring EQ-5D-5L with the new UK value set [Internet]. Rotterdam: EuroQol Research Foundation; [date unknown] [updated 2026 Aug 31; cited 2026 Nov 1]. Available from: https://euroqol.org/information-and-support/resources/new-uk-5l-value-set/
9. Rowen D, Mukuria C, Bray N, Carlton J, Longworth L, Meads D, et al. A United Kingdom value set for the EQ-5D-5L. Value Health. 2026;29(5):858-69. Available from: https://eprints.whiterose.ac.uk/id/eprint/239515/25/PIIS1098301526001105.pdf
10. NICE Decision Support Unit. Mapping between EQ-5D-5L and EQ-5D-3L [Internet]. Sheffield: University of Sheffield; [date unknown] [updated 2026 Apr; cited 2026 Nov 1]. Available from: https://sheffield.ac.uk/nice-dsu/methods-development/mapping-eq-5d-5l-3l
11. Wailoo A, Navega Biz A, Hernández Alava M. What is the impact of EQ-5D-5L vs 3L on NICE severity weights? NICE Decision Support Unit report [Internet]. Sheffield: University of Sheffield; 2026 Feb [cited 2026 Nov 1]. Available from: https://sheffield.ac.uk/nice-dsu/methods-development/what-impact-eq-5d-5l-vs-3l-nice-severity-weights
12. National Institute for Health and Care Excellence. NICE technology appraisal and highly specialised technologies guidance: the manual (PMG36), chapter 6: committee recommendations, section 6.2 and table 6.1 [Internet]. London: National Institute for Health and Care Excellence; [date unknown] [updated 2026 Oct 13; cited 2026 Nov 1]. Available from: https://www.nice.org.uk/process/pmg36/chapter/committee-recommendations
13. National Institute for Health and Care Excellence. Interim methods statement: implementing the EQ-5D-5L value set (PMG51). Process considerations [Internet]. London: National Institute for Health and Care Excellence; 2026 Aug 27 [cited 2026 Nov 1]. Available from: https://www.nice.org.uk/process/pmg51/chapter/process-considerations
14. National Institute for Health and Care Excellence. Interim methods statement: implementing the EQ-5D-5L value set (PMG51). Introduction [Internet]. London: National Institute for Health and Care Excellence; 2026 Aug 27 [cited 2026 Nov 1]. Available from: https://www.nice.org.uk/process/pmg51/chapter/introduction
15. National Institute for Health and Care Excellence. Interim methods statement: implementing the EQ-5D-5L value set (PMG51). Next steps [Internet]. London: National Institute for Health and Care Excellence; 2026 Aug 27 [cited 2026 Nov 1]. Available from: https://www.nice.org.uk/process/pmg51/chapter/next-steps
16. National Institute for Health and Care Excellence. Modular update to NICE manuals: EQ-5D-5L value set (GID-NGC10027) [Internet]. London: NICE; in development [cited 2026 Nov 1]. Available from: https://www.nice.org.uk/guidance/indevelopment/GID-NGC10027
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18. All Wales Therapeutics and Toxicology Centre. Guidance notes for the Submission Form for AWMSG Health Technology Assessment, section 12 [Internet]. Cardiff: All Wales Therapeutics and Toxicology Centre; 2025 Jun [cited 2026 Nov 1]. Available from: https://awttc.nhs.wales/accessing-medicines/pharmaceutical-industry/industry-submission-forms-new-process/hta-submission-form-guidance-notes-final-june-2025/
19. National Centre for Pharmacoeconomics. HTA guidelines [Internet]. Dublin: National Centre for Pharmacoeconomics; [date unknown] [cited 2026 Nov 1]. Available from: https://www.ncpe.ie/submission-process/hta-guidelines/
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Sources accessed October 2026. This article is analysis for information and is not legal, regulatory or tax advice.