Consultation on proposed increase of the Budget Impact Test threshold in England

On July 31, 2024, NHS England and the National Institute for Health and Care Excellence (NICE) published a consultation document that sets out the proposal to increase the Budget Impact Test (BIT) threshold from £20 million to £40 million. The BIT was introduced in 2017, and it applies during NICE's technology evaluation process.

NHS England and NICE are jointly responsible for the BIT threshold. NICE, through the Resource Impact Assessment (RIA) team, is responsible for independently assessing budget impact and identifying where the threshold is likely to be exceeded. At the same time, NHS England is responsible for commercial discussions following the identification of the threshold potentially being exceeded. 

Currently, the BIT threshold is considered exceeded if the budget impact is expected to be greater than £20 million in any of the first three years of a technology's use in the NHS. Budget impact and the application of the BIT do not influence NICE's consideration of the clinical and cost-effectiveness of a technology.

Increasing the BIT threshold to £40 million will ensure the BIT continues to target those technologies presenting the greatest budget impacts for the NHS while ensuring that the threshold is only exceeded in a minority of evaluations, in line with the intention of the original BIT policy.

The deadline for comments submission is September 25, 2024.

See the full details here.

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