NICE’s cost‑effectiveness threshold has become a political fulcrum for the NHS. Set two decades ago at £20,000–£30,000 per QALY and effectively frozen in nominal terms, it has lost purchasing power and strained access to new medicines. Calls to index the threshold to inflation are understandable, but simplistic indexing risks decoupling price from real health outcomes and displacing routine care that delivers greater health per pound. If we want a system that protects equity, fosters effective innovation and maximises population health, EVIDENCE must drive any reset.
