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Rapid Responses: Rapid Responses published:
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Transparency of NICE hypertension guideline
- Philip R Alderson, Mercia Page, Peter Littlejohns (25 April 2007)
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Re: Transparency of NICE hypertension guideline
- Tom Fahey (26 April 2007)
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Philip R Alderson, Associate Director, Centre for Clinical Practice NICE, MidCity Place, 71 High Holborn, London WC1V 6NA, Mercia Page, Peter Littlejohns
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Tom Fahey questions the transparency of the model used in the 2006 update of the NICE (National Institute for Health and Clinical Excellence) hypertension guideline and of the process of stakeholder consultation to which he contributed [1]. Sadly, both criticisms are inaccurate. The 2006 NICE hypertension guideline brought together NICE and the British Hypertension Society in developing a single guideline, using robust methods to consider both clinical and cost effectiveness [2]. The fact that Fahey was able to contribute detailed, constructive criticism of the guideline model’s assumptions illustrates the transparency with which the model was laid bare for public consultation. His comments on behalf of the Royal College of General Practitioners were considered by the guideline development group, along with many others, and influenced the final model and recommendations. For example, many stakeholders asked that heart failure was given more prominence as an adverse outcome in the model, and this was done. All comments from registered stakeholders are available, together with the developers’ responses, in a 126 page document available on NICE’s website at http://guidance.nice.org.uk/page.aspx?o=394279. We are unclear why Fahey should contrast NICE with SIGN’s (Scottish Intercollegiate Guidelines Network) methods as SIGN do not routinely undertake economic modelling. Fahey’s criticisms of the transparency of arrangements for stakeholder involvement is in contrast to the view expressed by the World Health Organization when they reviewed NICE’s clinical guidelines programme in 2006. Their independent report [3] states that “Collaboration with stakeholders in the development of the guidelines through the consultation and feedback mechanisms available was in general very effective”. References [1] Fahey, T. Transparency in NICE: Construction and assumptions of models should be explicit. BMJ 2007;334:814, doi:10.1136/bmj.39185.472743.3A [2] National Institute for Health and Clinical Excellence (April 2007) The Guidelines manual. London: National Institute for Health and Clinical Excellence. Available from: www.nice.org.uk [3] World Health Organization. The Clinical Guideline Programme of the National Institute for Health and Clinical Excellence (NICE): a review by the World Health Organization May 2006. Copenhagen: WHO, 2007. 2007 (EUR/05/5063284) Competing interests: None declared |
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Tom Fahey, Professor of General Practice & Family Medicine Royal College of Surgeons in Ireland Medical School
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Editor, I thank Phil Alderson and colleagues at NICE for responding to my letter. I would like to respond to their comments: Firstly, I would like to apologize for not correctly locating the stakeholders comments on the NICE website. Prior to posting my letter I did look carefully for stakeholders comments in response to the updated hypertension guidelines. I was only able to locate the stakeholders comments to the initial set of hypertension guidelines. These were entitled "Hypertension, first consultation- stakeholders comments". Unfortunately, I did not locate stakeholders comments to the updated hypertension guidelines as they are called "Hypertension update- consultation table". My apologies to the NICE group but would ask if the stakeholders comments could be more clealy marked in the future. Secondly, the main issue concerning transparency of the Makov modelling, the point made by Maynard in the orginal editorial remains.[1] When we published a Markov model of hypertension treatment, we were asked for and provided the full model, as well as the estimates concerning probabilities, utilities and costs.[2] This explicit approach is consistent with the approach recommended by peer-review journals, so that transparency and reproducility is acheived.[3] As Maynard observes, conflict between stakeholders is inevitable.[1] Surely the best way to address this issue is to publish rather than withold the Markov model on which clincial guidelines are based? Tom Fahey References 1. Maynard A. Transparency in health technology assessments: should NICE have the right to refuse access to its modelling data? BMJ 2007;334:594-5. 2. Montgomery A, Fahey T, Harding J, Ben Shlomo Y. The influence of absolute cardiovascular risk, patient utilities and costs on the decision to treat hypertension: A Markov Decision Analysis. Journal of Hypertension 2003; 21: 1753-59 3. Laine C, Goodman SN, Griswold ME, Sox HC. Reproducible research: moving toward research the public can really trust. Ann Intern Med 2007;146:450-453. Competing interests: None declared |
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