The National Institute for Health and Clinical Excellence, and otolaryngology: review of the evidence

Abstract

This review describes the Institute's methodology, examines guidance relevant to otolaryngology and presents more recent research to update the evidence.

Endoscopic sphenopalatine artery ligation for acute idiopathic epistaxis. Do anatomical variation and a limited evidence base raise questions regarding its place in management?

“…From these, we selected and have made reference in the text to the following article types: systematic reviews, n = 3; 8 , 15 , 16 narrative reviews or algorithms, n = 8; 11 , 17 – 23 randomised controlled trials, n = 3; 24 – 26 non-randomised controlled studies, n = 4; 1 , 27 – 29 case series or cohort studies, n = 9; 30 – 38 surveys and audits, n = 5; 9 , 10 , 14 , 39 , 40 cost-effectiveness studies, n = 5; 12 , 13 , 41 – 43 anatomy studies, n = 6; 44 – 49 case reports, n = 5; 50 – 54 and historical articles, n = 6 2 7 …”

“…Despite these uncertainties, the technique has become standard practice. However, it lacks the evidence base for efficacy required by the UK National Institute for Health and Care Excellence to approve it under ‘normal measures’ as a new invasive procedure 17 …”

Technology and ENT

“…However, it is important that new advances are evaluated properly to ensure safety, efficacy and cost-effectiveness. In this respect, the UK is fortunate in having government bodies such as the National Institute for Health and Care Excellence (NICE), and the Scottish Intercollegiate Guidelines Network (SIGN), to regulate the introduction of new technology, which otherwise may be purely driven by a commercial market 2 …”

Counting the cost

“…1 The review article by Hamilton and colleagues in the present issue takes this topic one step further by considering cost-utility analysis as a method of decision-making in healthcare, and otolaryngology in particular. 2 As they explain in their article, 'utility value' is used as a measure of the strength of an individual's preference for a particular health state.…”