The National Institute for Health and Care Excellence (NICE) has implemented revised cost-effectiveness thresholds for medicines and other technologies, following a government decision to raise the range used in technology appraisals to £25,000 to £35,000 per quality-adjusted life year (QALY) gained, and has updated its manual so that independent appraisal committees apply the change immediately to new and ongoing evaluations. NICE states that QALYs are used to measure both length and quality of life in order to compare new treatments with existing NHS care, and that the higher thresholds are intended to improve patient access to effective treatments while reflecting government choices on NHS spending and supporting the life sciences sector. NICE estimates that the change could allow an additional three to five medicines or new indications to be approved each year, on top of its current recommendation rate of around 91 per cent of medicines evaluated. Under the updated framework, committees continue to assess clinical effectiveness and value for money using evidence from studies, expert input and patient experience, while also considering uncertainty, disease severity, health inequalities, wider NHS effects and opportunity costs. Recommendations may range from routine use to restricted use, managed access, evidence generation or research-only use, but technologies will not be recommended where the evidence does not show sufficient benefit or value for NHS resources; NICE also states that decisions must be transparent and clearly justified by reference to the evidence, consultation responses and relevant legal and policy duties.