Original Article
Median life span of a cohort of National Institute for Health and Care Excellence clinical guidelines was about 60 months

https://doi.org/10.1016/j.jclinepi.2013.07.012Get rights and content

Abstract

Objectives

To describe the length of time National Institute for Health and Care Excellence (NICE) clinical guidelines have remained valid.

Study Design and Setting

The present study is a survival analysis of a cohort of published NICE clinical guidelines. The National Health Service in England and Wales uses NICE clinical practice guidelines as a reference for treatment and care of individuals. They need to be updated as new evidence arises, to remain credible and relevant, and are currently assessed 3 years after publication.

Results

Survival analysis suggested that about 86% of guidelines are still up-to-date 3 years after their publication. The median life span was 60 months (95% confidence interval: 51, 69).

Conclusion

These findings are similar to those in other studies of the life span of guidelines. Efficient mechanisms must be in place to detect the minority of guidelines that become outdated quickly.

Introduction

What is new?

  • In a cohort of National Institute for Health and Clinical Excellence (NICE) clinical practice guidelines, about 86% are still up-to-date 3 years after publication.

  • The median life span was 60 months (95% confidence interval: 51, 69).

  • This is the first such analysis of NICE guidelines but is similar to previous estimates of other clinical guidelines.

  • Efficient mechanisms must be in place to detect the minority of guidelines that go out of date rapidly.

More than 135 clinical practice guidelines have been published by the UK National Institute for Health and Clinical Excellence (NICE) since 2002. These outline recommendations for diagnosis, treatment, and care of people with specific diseases and conditions, based on the best available evidence of clinical and cost-effectiveness [1]. As new evidence arises such as new trials or when costs of drugs change, guidelines may need to be updated. This ensures that they remain credible summaries of current best practice.

Although there is international consensus on the features of clinical practice guideline development that ensure rigor [2], [3], there is more uncertainty about the process that should be used to identify how and when guidelines need updating [4]. Part of the reason for this is the lack of empirical data on how frequently guidelines have been judged to require updating, although one study by Shekelle et al. [5] investigated the longevity of 17 guidelines published by the US Agency for Healthcare Research and Quality (AHRQ).

NICE's policy on assessing the need to update a guideline has changed over time, from a commitment to assess the need for an update at 2 and 4 years after publication to the current policy [1] of an initial assessment 3 years after publication with variable follow-up after that. Currently, the assessment of the need to update involves literature review, intelligence from NICE's implementation team and postpublication queries, expert opinion from the original guideline development group, recommendations from the original guideline developer, consultation with stakeholders, and a final decision by NICE's guidance executive. As part of revisiting NICE's policy on assessing the need for updating guidelines, we decided to analyze how many of our clinical practice guidelines have needed updating and how long after publication this happens.

Section snippets

Methods

We analyzed data on NICE clinical practice guidelines. The dates for publication (rounded to the first day of the next month) and any decision to update (taken as the end of the month of a decision) were recorded; however, the specific methodology for assessing the need to update a guideline (referred to in this article as an assessment) was not examined. All clinical guidelines published by NICE were considered for the study, but we excluded any guideline in which a decision to update had

Results

Of the 135 NICE clinical practice guidelines published from 2002 to the end of the study period, 134 were included for analysis in this study. One was excluded because a decision to update and incorporate it into a new guideline had been made before it was published. Of the 134 guidelines included in the analysis, 119 were published new guidelines and 15 were published updated guidelines. Seventy-seven have been assessed for the need to update to date, 17 of which have been assessed twice

Discussion

About 86% of NICE clinical practice guidelines are still judged up-to-date within 3 years of their publication, and median survival is about 5 years. This study has been the biggest of its kind with more than 100 clinical guidelines included. Even so, only 77 guidelines have been assessed for updating in this analysis, meaning that there are not many judged to be outdated events to base the analysis on. Conclusions therefore need to be tentative. We plan to repeat the analysis with more data to

Acknowledgments

The authors thank Susan Latchem, Judith Thornton, Beth Shaw, Sharon Summers-Ma, and Fergus Macbeth for their thoughtful comments and feedback on the draft manuscript.

Ethics: No ethical approval was needed for this study.

Authors contributions: L.J.H.A. and T.T. carried out the data analysis on centrally held data for the Center for Clinical Practice at NICE, and L.J.H.A. drafted the manuscript. P.A. and T.T. helped to draft the manuscript. P.A. conceived of the study and participated in its

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Competing interest: None of the authors has a known conflict of interest affecting this article.

Funding: P.A. and T.T. are full-time employees of NICE. L.J.H.A. undertook this work while on an unpaid work placement at NICE.

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