Clinical Guidelines: A NICE Way to Introduce Cost-Effectiveness Considerations?

Area of Science:

• Health economics
• Clinical guideline development
• Public health policy

Background:

• The National Institute for Health and Care Excellence (NICE) established its clinical guidelines program in 2001.
• Over 200 guidelines have been published, integrating cost-benefit analyses into recommendations.
• The program emphasizes collaboration with the medical profession and comprehensive pathway reviews.

Purpose of the Study:

• To evaluate the structure, advantages, and challenges of the NICE clinical guidelines program.
• To assess the role of economic evaluations in healthcare decision-making within the UK.
• To highlight the unique aspects of NICE guidelines, including disinvestment discussions.

Main Methods:

• Systematic review of economic evaluation literature included in guidelines.
• Analysis of de novo economic analyses conducted for guidelines published between January 1 and August 31, 2015.
• Examination of program advantages and challenges, including collaboration, pathway review, and disinvestment.

Main Results:

• NICE guidelines systematically review economic evaluations, with 28 de novo analyses in 12 guidelines from early 2015.
• Key advantages include medical profession collaboration, holistic clinical pathway review, and consideration of disinvestment.
• Challenges involve balancing individual patient care with public health objectives (equity, fairness, efficiency) and time constraints for economic analyses.

Conclusions:

• The NICE clinical guidelines program effectively integrates economic evaluations into healthcare recommendations.
• The program's collaborative approach and comprehensive scope are significant strengths.
• Tensions between individual care quality and public health goals, alongside resource limitations, present ongoing challenges for the program.