NICE clinical guidelines

Editor—Wailoo et al raise important issues but misunderstand aspects of the NICE programme.¹ They criticise the “confusion” between the views of society and those of patients. Guideline development groups are not confused; health economics are fully considered and not rated second best. Wailoo et al imply that the focus on efficacy arises because guideline development groups consist substantially of senior clinicians with special interests. This is inaccurate. Guideline development groups contain such clinicians but also a majority of general clinicians, practitioners, and general patients.

Wailoo et al imply that health economic data from randomised controlled trials are often the only data used. This is incorrect. Considerable use is made of data from other sources and economic models are developed. Guideline development groups also apply considerable judgment when developing recommendations from efficacy data; relevant factors include study populations, costs, and the application to the NHS, all of which influence recommendations.

The purpose of clinical guidelines is to encourage best practice by making available knowledge of efficacious, effective, and cost effective treatments, thereby reducing variation in the delivery of health interventions. This is best dealt with through a guideline development programme that fully integrates cost and efficacy data.

Their proposals for improving cost effectiveness are impractical. Guidelines are concerned with the treatment of a disease and not the application of a technology, and this is a more complex process than implied by the analogy with technology appraisals. Health economists need to be better informed about clinical guidelines, and health economic data need to improve, along with the methods for applying them to guideline development. We are convinced that this can be best achieved through development of the existing process, in which we expect health economics to have a crucial role.