2 Research recommendations

The Guideline Development Group has made the following recommendations for research, based on its review of evidence, to improve NICE guidance and patient care in the future.

2.1 Pain management for patients with an acute painful sickle cell episode

For patients with an acute painful sickle cell episode, what are the effects of different opioid formulations, adjunct pain therapies and routes of administration on pain relief and acute sickle cell complications?

Why this is important

Limited evidence is available on the effectiveness of different opioid formulations, routes of administration and adjunct therapies in the treatment of an acute painful sickle cell episode. A series of RCTs should be conducted that compare the effects of different opioid formulations, adjunct pain therapies and routes of administration. These RCTs should be conducted separately in adults and children, and cover the duration of the acute painful episode. Outcomes should include pain and adverse events such as acute chest syndrome.

2.2 Use of low-molecular-weight heparin to treat patients with an acute painful sickle cell episode

Are therapeutic doses of low-molecular-weight heparin (LMWH) effective, compared with prophylactic doses of LMWH, in reducing the length of stay in hospital of patients with an acute painful sickle cell episode?

Why this is important

Moderate-quality evidence from one RCT suggested a significant benefit of treating patients with an acute painful sickle cell episode with LMWH. This was supported by exploratory health economic analyses suggesting a large reduction in length of stay and associated costs. An RCT should be conducted that examines the effect of therapeutic doses of LMWH, compared with prophylactic doses, on the length of stay in hospital of patients with an acute painful sickle cell episode. The RCT should be conducted separately in adults and children, and cover the duration of the painful episode.

2.3 Non-pharmacological interventions for patients with an acute painful sickle cell episode

For patients with an acute painful sickle cell episode, are non-pharmacological interventions, such as massage, effective in improving their recovery from the episode?

Why this is important

There was a lack of evidence on the potential benefits of supportive interventions for patients with an acute painful sickle cell episode. An RCT should be conducted that examines the effect of providing rehabilitation interventions that are aimed at improving a patient's recovery after an acute painful sickle cell episode. Such interventions could include massage and physical therapy. The intervention should be provided within the hospital setting, and patients should be followed up 7 days after the episode. Data should be collected to inform outcomes such as length of stay, health-related quality of life and coping strategies.

2.4 Cost effectiveness of daycare units for treating patients with an acute painful sickle cell episode

Are daycare units cost effective compared with emergency settings for treating patients with an acute painful sickle cell episode?

Why this is important

There was a lack of evidence on the cost effectiveness of daycare units for treating patients with an acute painful sickle cell episode in the UK. A trial should be carried out that compares treating patients with an acute painful sickle cell episode in an emergency department setting and in a specialist sickle cell daycare unit. Outcomes should include health-related quality of life (HRQoL). Data should be collected using validated measure(s) of HRQoL, including EQ-5D

  • National Institute for Health and Care Excellence (NICE)