Reply from chairman of appraisal committee at NICE

EDITOR—In commenting on the National Institute for Clinical Excellence's guidance on riluzole Sandercock et al show the difference between assessment and appraisal of evidence.1 One form of evidence used in an appraisal is a formal systematic review. The assessment report does not make recommendations on how the technology should be used in the NHS; that is the job of the institute's appraisal committee. The committee also receives submissions from patient and professional organisations, which provide perspectives not captured by a formal review of published evidence.

The committee takes account of the clinical need of patients and the broad balance of benefits and costs of the technology. Its conclusions are subject to consultation and can be appealed against. This is all some distance on from the original assessment of the evidence.

Sandercock et al suggest that a superficial reading of the guidance may not give an adequate understanding of the evidence base for riluzole. The institute's guidance identifies what the committee considered to …