The Pharmaceutical Journal Vol 264 No 7078 p46
January 8, 2000 News

The SIGN is more prescriber focused than the NICE, meeting is told

The National Institute for Clinical Evidence (NICE) tends towards a more regulatory model of guideline production, whereas the Scottish Intercollegiate Guidelines Network (SIGN) is more prescriber focused, said Professor Martin Buxton (director, Health Economics Research Group, Brunel university) at the 11th annual scientific meeting of the Drug Utilisation Research Group on December 10, 1999. He described two models for assessing patient management. The first was regulatory, in which mechanisms were set up for centralised decisions and recommendations were produced regarding what could be prescribed and when. This restricted prescribing of some items but provided clear, consistent health care provision nationally. This model required economic head-to-head studies of drugs or treatments.

The Scottish Intercollegiate Guidelines Network (SIGN) national guidelines for local use are now available free of charge within the NHS in Scotland and on the SIGN website www.sign.ac.uk

The second model was prescriber focused. In this case, information was provided to prescribers with incentives to prescribe in a cost effective manner. In this case, prescribing reflected local circumstances, which might lead to local variation in health care provision.
Professor Buxton commented that the main problem with both models was a lack of good data on the comparative efficacy of medicines and, particularly, interventions. Even basic, accurate cost data were not available for clinical conditions and systems.
The principle, therefore, had to be to offer the best care to the individual, subject to a "final check" that the cost of such treatment was not excessive. Ideally, guidelines would already have assessed this and doctors would not have to make such decisions for every prescription written.
During the production of guidelines, the following questions had to be answered: what was the threshold for treatment; was a confirmatory test really of any value; for how long should prescribers persist with cheap, first-line treatment; and in which groups did expensive drugs offer benefits?
Cost effectiveness had to be built in right from the beginning of guideline production and prescribing. It should not be bolted on at the end, he concluded.