NICE has updated how it values quality of life - the move from 3L to 5L

This week, NICE confirmed it is adopting the UK EQ-5D-5L value set. Alan Lamb explains what this is and considers the potential impact for patients

How does NICE measure quality of life?

To help NICE decide whether the NHS should fund a new treatment, it needs a way to measure how much that treatment improves a patient's quality of life. To do this, researchers use a short questionnaire that asks patients to score their health across five areas - mobility, self-care, usual activities, pain, and anxiety - on a five-point scale.

How a treatment impacts the scores across this questionnaire helps inform NICE how much a patient's quality of life changes with that treatment. This is achieved by converting these answers into a single score, which is used to estimate the quality-adjusted life years (QALYs) a new medicine provides, so NICE can consider whether it is cost-effective for use on the NHS. To do this conversion, researchers use a ‘value set’. The ‘value set’ assesses what the UK public says it values about health by asking the public to compare a wide range of health states with being in perfect health.

What is changing – 3L to 5L

On 27 August 2026, NICE published an interim methods statement confirming that it will adopt the EQ-5D-5L value set as the basis for valuing health-related quality of life in its medicine appraisals and guidelines, replacing the EQ-5D-3L value set, which had been in use since 2012. [1]  The EQ-5D-5L value set reflects more recent research into societal preferences as a basis for the QALY calculations that underpin NICE’s cost-effectiveness assessments. Moving from 3L to 5L may not sound like much of a change, but it could have implications for access to medicines for patients.

NICE consulted on the proposed change earlier this year. As part of our response to this consultation, the ABPI conducted a retrospective impact assessment across 71 technology appraisals, reinforcing NICE's findings: the effects vary by therapy area. [2]

How will the change to how NICE measures quality of life impact patients?

In general, treatments that extend how long people live tend to become more cost-effective under the new value set, while treatments that improve quality of life without extending it tend to become less cost-effective. The ABPI’s impact assessment found that there could be loss of, or restricted access to, some medicines that are less cost-effective using the 5L value set.

Because the effect of the change differs between therapy areas and types of treatment, its practical consequences will only become clear as evaluations work through the system. The ABPI considers that the impact and implementation of EQ-5D-5L will now need to be monitored closely, with additional mitigations put in place if it prevents access to new medicines.

Methods updates of this kind are intended to keep NICE’s decisions aligned with what people in the UK value about their health. Whether this is the case will be demonstrated by patients' continued ability to access treatments that matter for them, promptly and equitably, across all types of conditions.

[1] NICE, ‘Interim methods statement: implementing the EQ-5D-5L value set’, August 2026, accessed August 2026, available at https://www.nice.org.uk/process/pmg51

[2] Biz A.N., Alava M.H., Wailoo A., ‘Switching From EQ-5D-3L to EQ-5D-5L in England: The Impact in NICE Technology Appraisals’, May 2026, accessed August 2026, available at https://doi.org/10.1016/j.jval.2026.03.007