The National Institute of Health and Care Excellence (NICE) makes recommendations for the use of interventions including medicines in the National Health Service in England based on their clinical and cost-effectiveness. Over the last 20 years 82% of technology appraisal recommendations have been ‘positive’. However, around one third of these are ‘optimised’ recommendations. In this report we quantify the patient access associated with NICE ‘optimised’ recommendations.

We evaluated optimised recommendations published between 2015 and 2019; 40 contained sufficient information to estimate recommended patient access levels. In about two-thirds (65%) of optimised recommendations evaluated, NICE recommended use for less than half of eligible patients. While the justification for these restrictions may be well-founded, more granular reporting of recommendations would help paint a more accurate picture of recommended levels of patient access associated with NICE decision outcomes.