NICE measures severity by comparing the QALYs that people with the condition can expect with current NHS care against the QALYs the general population of the same age and sex can expect. Enter the population and your comparator QALYs. The results update as you type.[1, 2, 3]
How the weight is set
| QALY weight | Proportional QALY shortfall | Absolute QALY shortfall |
|---|---|---|
| 1 | Less than 0.85 | Less than 12 |
| x1.2 | 0.85 to 0.95 | 12 to 18 |
| x1.7 | At least 0.95 | At least 18 |
The weight follows whichever measure implies the greater severity, and a value exactly on a cut-off takes the higher weight. The weight multiplies incremental QALYs. Since 2026, NICE uses £25,000 and £35,000 per QALY as its reference points, and the severity cut-offs and weights are unchanged.[4, 5]
Getting the inputs right
- Population: use the mean age and sex mix of people at the point in the pathway where the technology would be used, consistent with the model baseline.
- Comparator QALYs: use total QALYs for established NHS practice over a lifetime horizon, discounted at 3.5% even where 1.5% is accepted for the cost-effectiveness analysis. Exclude carer QALYs.
- Value set: topics with an invitation to participate after 27 August 2026 use EQ-5D-5L utilities and 5L norms. Topics already under way continue with 3L.
- Several comparators: where more than one comparator reflects NHS practice, calculate the shortfall for each one.
- Whole years: the DSU calculator uses whole-year ages, so decimal ages are rounded here.
For how the modifier has been applied since 2022, and where submissions gain or lose a weight, read the NICE severity modifier explained.
References
- National Institute for Health and Care Excellence. technology appraisal and highly specialised technologies guidance, the manual (PMG36), section 6.2 and table 6.1 [Internet]. London: National Institute for Health and Care Excellence; [date unknown] [cited 2026 Oct]. Available from: https://www.nice.org.uk/process/pmg36/chapter/committee-recommendations
- Wailoo A. A guide to calculating severity shortfall for NICE evaluations. NICE DSU Technical Support Document 23, and severity calculator [Internet]. Sheffield: NICE Decision Support Unit, University of Sheffield; 2024 Jan [updated 2026 Sep; cited 2026 Oct]. Available from: https://sheffield.ac.uk/nice-dsu/tsds/severity-shortfall-tsd
- McNamara S, Schneider PP, Love-Koh J, Doran T, Gutacker N. Quality-adjusted life expectancy norms for the English population. Value Health. 2023;26(2):163-9. Available from: https://pubmed.ncbi.nlm.nih.gov/35965226/
- National Institute for Health and Care Excellence. interim methods statement on implementing the EQ-5D-5L value set (PMG51) [Internet]. London: National Institute for Health and Care Excellence; 2026 Aug 27 [cited 2026 Oct]. Available from: https://www.nice.org.uk/process/pmg51/chapter/introduction
- National Institute for Health and Care Excellence. changes to NICE's cost-effectiveness thresholds confirmed [Internet]. London: National Institute for Health and Care Excellence; 2025 Dec 1 [cited 2026 Oct]. Available from: https://www.nice.org.uk/news/articles/changes-to-nice-s-cost-effectiveness-thresholds-confirmed
Rules reviewed October 2026. This calculator is indicative and independent of the agencies; check the latest official texts before submission.
