Assessment of NICE guidance on two surgical procedures

doi:10.1016/S0140-6736(04)16180-1

The Lancet

Volume 363, Issue 9420, 8 May 2004, Pages 1525-1526

https://doi.org/10.1016/S0140-6736(04)16180-1 Get rights and content

Summary

The National Institute of Excellence (NICE) released its first guidance in 2000 on clinical procedures and technologies in England and Wales. Using hospital activity data, we looked at the effect of NICE guidance on wisdom tooth extraction and primary total hip replacement in the UK National Health Service. We selected hospitals that submitted their activity continuously between 1997 and 2002. Analysis of wisdom tooth extraction showed that NICE guidance was not the primary reason for the downward trend in extractions (p=0·8287); this trend was more likely to be attributable to previous guidance. For total hip replacement there was no significant change in behaviour away from use of non-cemented hip prostheses. Therefore, NICE guidance has had little effect on behaviour for these two procedures.

References (6)

Guidance on Removal of Wisdom Teeth (Technology Appraisal Guidance, number 1)
(2000)
Guidance on the Selection of Prostheses for Primary Total Hip Replacement (Technology Appraisal Guidance, number 2)
(2000)
R Thwaites et al.
Nosocomial Respiratory Syncytial Virus Infection in Neonatal Units in the UK
Acta Paediatr
(2004)

There are more references available in the full text version of this article.

Cited by (24)

A Review of Empirical Analyses of Disinvestment Initiatives
2017, Value in Health
Disinvesting in low-value health care services provides opportunities for investment in higher value care and thus an increase in health care efficiency.
To identify international experience with disinvestment initiatives and to review empirical analyses of disinvestment initiatives.
We performed a literature search using the PubMed database to identify international experience with disinvestment initiatives. We also reviewed empirical analyses of disinvestment initiatives.
We identified 26 unique disinvestment initiatives implemented across 11 countries. Nineteen addressed multiple intervention types, six addressed only drugs, and one addressed only devices. We reviewed 18 empirical analyses of disinvestment initiatives: 7 reported that the initiative was successful, 8 reported that the initiative was unsuccessful, and 3 reported that findings were mixed; that is, the study considered multiple services and reported a decrease in the use of some but not others. Thirty-seven low-value services were evaluated across the 18 empirical analyses, for 14 (38%) of which the disinvestment initiative led to a decline in use. Six of the seven studies that reported the disinvestment initiative to be successful included an attempt to promote the disinvestment initiative among participating clinicians.
The success of disinvestment initiatives has been mixed, with fewer than half the identified empirical studies reporting that use of the low-value service was reduced. Our findings suggest that promotion of the disinvestment initiative among clinicians is a key component to the success of the disinvestment initiative.
Burden or Relief: Do Second-Opinion Centers Influence the Quality of Care Delivered to Patients with Testicular Germ Cell Cancer?
2010, European Urology
Citation Excerpt :
The effectiveness of publishing guidelines without offering supporting measures is also questioned by other studies [11,12]. A publication by Ryan et al, for example, demonstrated that two National Institute for Health and Clinical Excellence guidelines had an only marginal effect because the applicable scale of fees counteracted their implementation [13]. One can only speculate about effective strategies for guideline implementation.
To improve the quality of care, the German Testicular Cancer Study Group (GTCSG) has been publishing a series of testicular germ cell cancer guidelines since 1996. These guidelines were updated in the 2008 publication, “European Consensus on Diagnosis and Treatment of Germ Cell Cancer.” Several studies have shown that published guidelines have a limited effect on clinical practice. For this reason, the GTCSG made a further effort in 2006 to improve the quality of care by establishing a national second-opinion system for therapy planning for patients who underwent orchiectomy and staging evaluations.
The primary aim was to analyze the influence of the second-opinion system on guideline implementation with a view to improving the quality of care.
An Internet data exchange was established between the urologist seeking advice and the second-opinion centers. Second-opinion centers were 18 clinics that had contributed toward developing treatment guidelines.
Data sets included the primary clinical, radiologic, and pathohistologic data; the planned therapy; the therapy recommended by the second-opinion center; and the follow-up.
From February 2006 to September 2008, 642 second opinions were requested. The therapy planned by the urologist seeking advice differed from that recommended by the second-opinion center in 32.3% of the cases. The discrepancy was significantly higher for nonseminomas than for seminomas (p = 0.045) and showed a tendency to increase with advancing tumor stage (p = 0.067). In cases of discrepancy, the applied therapy coincided with the second opinion in 71.8% of the cases. A discrepant second opinion prevented overtreatment in 40.3% and undertreatment in 26.5%.
Approximately every sixth second opinion resulted in a relevant change in the scope of therapy. Published guidelines for germ cell cancer are applied only sporadically and should be supported by second-opinion systems.
Paper tigers - Do clinical guidelines improve health care quality in patients with testicular germ cell tumors in Germany?
2006, Health Policy
Citation Excerpt :
Skepticism regarding the positive effect of merely publishing national guidelines without changing the care structure is reinforced by considering national guidelines for other diseases. A study by Ryan et al. shows that the procedures applied to extract wisdom teeth and select prostheses for primary hip replacement were not greatly affected by the publication of guidelines by the National Institute of Excellence (NICE) in England and Wales [14]. The NICE recommendations to use cemented prostheses and to refrain from operating on pathology-free impacted third molars had no independent effect on existent trends in the therapeutic procedure.
In Germany, germ cell tumors are characterized by a marked excess mortality, i.e. a discrepancy between the actual mortality and the mortality expected with adequate implementation of the standard therapy. Moreover, Germany not only has a significantly increased mortality in an international comparison but also shows marked regional differences in the quality of medical care. This is partly due to difficulties in implementing the standard therapy. An attempt was made to improve the quality of medical care by setting up evidence-based diagnostic and therapeutic guidelines in 1996. Contrary to expectations, however, these guidelines have thus far remained largely ineffective, their implementation being hampered by a solely passive dissemination strategy. Added to this are inadequate medical care structures in which the guidelines cannot be properly implemented because of the organizational, social and professional context. Decisive for a quality improvement in the diagnosis, therapy and care of germ cell tumor patients is active dissemination of the guidelines supplemented by a change in the care structure. It is also important to establish indicators for measuring the success of guideline implementation and to perform continuous progress monitoring in order to specifically overcome evident barriers. Future research is required to create a better theoretical basis and to develop further strategies for guideline dissemination and implementation.
Assessment of NICE guidance [2] (multiple letters)
2004, Lancet
Does the National Institute for Health and Clinical Excellence only appraise new pharmaceuticals?
2007, International Journal of Technology Assessment in Health Care
International diffusion of new health technologies: A ten-country analysis of six health technologies
2006, International Journal of Technology Assessment in Health Care

View all citing articles on Scopus

View full text

Research LettersAssessment of NICE guidance on two surgical procedures

Summary

Guidance on Removal of Wisdom Teeth (Technology Appraisal Guidance, number 1)

Guidance on the Selection of Prostheses for Primary Total Hip Replacement (Technology Appraisal Guidance, number 2)

Nosocomial Respiratory Syncytial Virus Infection in Neonatal Units in the UK

Acta Paediatr

Research Letters
Assessment of NICE guidance on two surgical procedures