Readers who have accessed guidance on the website of the National Institute for Health and Clinical Excellence (NICE) recently will have seen an announcement that “NICE and the Department of Health are currently reviewing the future position on updating technology appraisals within clinical guidelines (CGs), with particular reference to implications for the funding direction on technology appraisals (TAs)”.
Updating technology appraisal guidance (TAG) by means of CGs would certainly have interesting implications for funding, given the element of compulsion behind the TA which exists by virtue of the Secretary of State’s “directions to primary care trusts and NHS trusts in England concerning arrangements for the funding of technology appraisal guidance from the National Institute for Clinical Excellence”. By contrast, a clinical guideline is a “gold standard” – it sets out the best practice to which practitioners and commissioners should aspire. However, if they fail to achieve this in practice (because of, for example, funding constraints), they cannot be penalised .
Although surprising, however, this is not entirely without precedent. Causative of far greater consternation is the website suggestion that TA107 Trastuzumab [Herceptin] (for the adjuvant treatment of early stage HER-2 positive breast cancer) “remains available and should continue to be followed”, while CG80 (“Early and locally advanced breast cancer: diagnosis and treatment”) states that it “updates and replaces NICE technology appraisal 109, 108 and 107”.
We contacted NICE to point out the inconsistencies in these various statements and have been told that the website may be amended shortly. We recommend that commissioners and providers join us in watching the website carefully for the anticipated clarification