Does the UK use £15,000, £30,000 or a £70,000 per QALY cost effectiveness threshold?

A de facto number that is used by National Institute for Health and Care Excellence (NICE) is £30,000 per quality adjusted life year (QALY). Some recent literature (Martin et al. 2023) argues for a lower cost-effectiveness threshold (£15,000/QALY or less) based on their marginal cost per QALY (MCPQ) estimates.

Alternatively, a paper by Sampson and Cookson (2024) rejects the use of MCPQ for setting cost-effectiveness threshold for future health technologies. They argue that

For practical questions, the absolute level of the MCPQ is, at best, a weak indicator of the past performance of the health service and an insufficient basis for informing future decisions.

Interestingly, the UK government does not use a single health valuation. Whereas NICE has a relatively low value for health gains, UK Department of Treasury states in their 2022 Green Book that:

The current monetary WTP [willingness to pay] value for a QALY is £70,000 in 20/21 prices.

Adjusting the Treasury’s figure for inflation (£82,510) and converting into USD, (1.2722 USD/GBP) this figure would correspond to about $105,000 per QALY, which is not too disimilar from commonly used US cost/QALY thresholds.

In short, it could be the case that the UK’s government’s value of health gains is similar to those of the US…except for the government departments (NHS, NICE) that actually pay for health care.