5 Process

NICE process and methods

Topics suitable for consideration by the Clinical Guidelines Updates Committee are usually identified through the NICE clinical guideline surveillance process. They are then agreed by NICE Guidance Executive.

A topic is normally considered to be suitable for a rapid review if a section of the guideline or a set of review questions form a discrete and distinct area of a clinical pathway. The following scenarios are likely to apply:

A small number of distinct review questions underpin a limited number of recommendations. The exact number will depend on the types of questions and the likely size of the evidence base to be reviewed.
Limited economic and costing analyses may be needed, such as the updating of incremental costs and benefits to calculate updated incremental cost-effectiveness ratios (ICERs), but no major new health economic modelling is needed.
No complex analyses are needed, such as questions involving a network meta-analysis or questions about diagnosis that would significantly affect the treatment pathway covered in the rest of the guideline.

Updates that need complex analyses or that have a major health economic component are unlikely to be suitable for the rapid update process at present.

There is no scoping stage for clinical guideline updates using standing committees (unlike a standard guideline update). This is because the rapid update considers only areas from the existing guideline, and so the review questions and review protocols will already be defined by the existing guideline. However, if the questions and/or protocols are unavailable or there is ambiguity in the existing guideline, the analysts may approach the topic-specific members of the committee for advice before starting the evidence review.

The committee meets quarterly. Each guideline undergoing rapid review is considered at 2 meetings. At meeting 1 the committee is presented with the updated evidence reviews conducted by the Internal Clinical Guidelines technical team and develops recommendations. After public consultation, the committee amends the recommendations as needed at meeting 2, which is usually the next quarterly meeting.

The committee submits the updated guidance to the NICE Centre for Clinical Practice, which carries out quality assurance for the update using existing internal processes and those outlined in the NICE guidelines manual 2012.