Nice Clinical Guideline on Managing Faecal Incontinence: Evidence of the Effectiveness and Cost-Effectiveness of Surgical Interventions

The NICE Osteoarthritis Guideline Development Group (GDG) has been challenged for not using the available acupuncture evidence in the most appropriate manner in three crucial areas. This response explains the methods used by the GDG with particular reference to the economic analysis, and illustrates that the methods used were those most appropriate for developing a NICE clinical guideline. The cost-effectiveness conclusions made by the GDG are supported by the currently available evidence.

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Inconsistencies in Nice Guidance for Acupuncture: Reanalysis and Discussion

Acupuncture in Medicine ◽

10.1136/acupmed-2012-010152 ◽

2012 ◽

Vol 30 (3) ◽

pp. 182-186 ◽

Cited By ~ 14

Author(s):

Nicholas R Latimer ◽

Aathish Chandrika Bhanu ◽

David G T Whitehurst

Keyword(s):

Cost Effectiveness ◽

Acupuncture Therapy ◽

Incremental Cost ◽

Usual Care ◽

Clinical Guideline ◽

Sham Acupuncture ◽

Economic Evaluations ◽

Control Group ◽

The Cost ◽

Nice Clinical Guideline

Background Acupuncture received a positive recommendation in the National Institute for Health and Clinical Excellence (NICE) clinical guideline for low back pain (LBP). However, no such recommendation was forthcoming in the NICE clinical guideline for osteoarthritis (OA). Importantly, the two guidelines adopted different treatment comparators in their economic analyses of acupuncture; in the LBP guideline ‘usual care’ was used (with no consideration of placebo/sham interventions), whereas ‘sham acupuncture’ was the comparator in the OA guideline. Objective To analyse the implications of using different control group comparators when estimating the cost-effectiveness of acupuncture therapy. Methods The NICE OA economic analysis for acupuncture was replicated using ‘usual care’ (ie, no placebo/sham component) as the treatment comparator. A ‘transfer-to-utility’ technique was used to transform Western Ontario and McMaster Osteoarthritis scores into EQ-5D utility scores to allow quality-adjusted life year (QALY) gains to be estimated. QALY estimates were combined with direct incremental cost estimates of acupuncture treatment to determine incremental cost-effectiveness ratios (ICERs). Results When ‘usual care’ was used as the treatment comparator, ICER point estimates were below £20 000 per QALY gained for each acupuncture trial analysed in the OA clinical guideline. In the original analysis, using placebo/sham acupuncture as the treatment comparator, ICERs were generally above £20 000 per QALY gained. Conclusion The treatment comparator chosen in economic evaluations of acupuncture therapy is likely to be a strong determinant of the cost-effectiveness results. Different comparators used in the OA and LBP NICE guidelines may have led to the divergent recommendations in the guidelines.

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Colorectal

Urogynaecology ◽

10.1093/med/9780198829065.003.0006 ◽

2020 ◽

pp. 111-126

Author(s):

Helen Jefferis ◽

Natalia Price

Keyword(s):

Rectal Prolapse ◽

Faecal Incontinence ◽

Rectovaginal Fistula ◽

Surgical Interventions ◽

Different Types ◽

Obstructed Defaecation

This chapter covers colorectal problems. It starts with different investigations for physiology, musculature, and transit, then goes on to discuss the causes, assessment, and management of constipation. Different types of laxatives are described. Specific conditions, including obstructed defaecation syndrome, rectal prolapse, and intussusception are covered. Causes, management, and surgical interventions of faecal incontinence are described. Finally, the causes and management of rectovaginal fistula are defined.

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