Adult Social Care Outcomes Toolkit and ICEpop Capability Measure in decision making: a review of NICE social care and public health guidelines

OBJECTIVES: 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. NICE's preferred measure of health-related quality of life is EQ-5D. For nonhealth effects, NICE cites Adult Social Care Outcomes Toolkit (ASCOT) and ICEpop Capability Measure (ICECAP) as possible outcomes. To date, to our knowledge, their use in NICE guidelines has not been reviewed. The objectives of this study were to (1) review how ASCOT and ICECAP have been used in NICE social care and public health guideliens and (2) contextualize the review via expert interviews. METHODS: NICE social care and public health guidelines published before August 26, 2025 were reviewed, and information on the use of ASCOT and ICECAP was extracted. Five experts were interviewed to contextualize the review findings. RESULTS: Of the eligible guidelines, ASCOT appeared as an outcome in 4% and ICECAP in 1%. Neither measure significantly affected committee's decision making. Interview findings were grouped into 2 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 because of 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 whether such measures may appear more in future NICE social care and public health guidelines.