Table 1.

Factors justifying recommendation of a technology above £20,000/QALY

2004 Methods guide (3rd edition) [36]	2008 Methods guide (4th edition) [41]	2013 Methods guide (5th edition) [46]	2008 SVJ (2nd edition) [40]
The degree of uncertainty surrounding the calculation of ICERs	The degree of certainty around the ICER. In particular, the Committee will be more cautious about recommending a technology when they are less certain about the ICERs presented	As per 2008 Methods guide	NICE should not recommend an intervention (that is, a treatment, procedure, action or programme) if there is no evidence, or not enough evidence, on which to make a clear decision
The innovative nature of the technology	The innovative nature of the technology, specifically if the innovation adds demonstrable and distinctive benefits of a substantial nature which may not have been adequately captured in the QALY measure	As per 2008 Methods guide	Decisions about whether to recommend interventions should not be based on evidence of their relative costs and benefits alone. NICE must consider other factors when developing its guidance, including the need to distribute health resources in the fairest way within society as a whole NICE can recommend that use of an intervention is restricted to a particular group of people within the population (for example, people under or over a certain age, or women only), but only in certain circumstances When choosing guidance topics, developing guidance and supporting those who put its guidance into practice, the Institute should actively consider reducing health inequalities including those associated with sex, age, race, disability and socioeconomic status
The particular features of the condition and population receiving the technology	Not included	The technology meets the criteria for special consideration as a ‘life-extending treatment at the end of life’
Where appropriate, wider societal costs and benefits	Not included	Aspects that relate to non-health objectives of the NHS
Not included	Whether there are strong reasons to indicate that the assessment of the change in health-related quality-of-life has been inadequately captured, and may therefore misrepresent the health utility gained	As per 2008 Methods guide	No close equivalent