ASCOT and ICECAP in decision-making: A review of NICE social care and public health guidelines.

Background: When the National Institute for Health and Care Excellence (NICE) assesses whether interventions in health and social care offer value for money, where possible, it considers health effects expressed in quality-adjusted life years (QALYs). NICE's preferred measure of health-related quality of life is the EQ-5D. For non-health effects, NICE cites ASCOT and ICECAP as possible outcomes. To date, their use in NICE guidelines has not been reviewed.

Objectives: The aims of this study were to 1) review how ASCOT and ICECAP have been used in NICE social care and public health guidelines and 2) contextualize the review via expert interviews.

Methods: NICE social care and public health guidelines published before 26/08/2025 were reviewed, and information on the use of ASCOT and ICECAP was extracted. Five experts were interviewed to contextualize review findings.

Results: Of the eligible guidelines, ASCOT appeared as an outcome in 4% and ICECAP in 1%. Neither measure significantly impacted committee's decision-making. Interview findings were grouped into two themes: (1) reasons behind the limited use of these measures (with 3 subthemes: conceptual, system-wide issues and implementation challenges); and (2) ongoing developments and future opportunities.

Conclusions: ASCOT and ICECAP appeared infrequently in the NICE guidelines reviewed, and when used, their impact on committee decision-making was limited-either due to trial-specific limitations or reliance on other forms of evidence. Experts suggested several barriers to the use of these measures, and although these barriers are not insurmountable, it is unclear if such measures may appear more in future NICE social care and public health guidelines.