8 Linking to other guidance
This chapter describes how guidelines link to other NICE guidance in the topic area and to guidance from other developers.
Related NICE guidelines and guidance on health technologies should be identified during scoping of a guideline (see the chapter on the scope), or when checking if a guideline needs updating (see the chapter on ensuring that published guidelines are current and accurate). This includes identifying any related guidance or guidelines in development, as well as those that are published.
When a guideline topic covers guidance on health technologies that is published or in development, NICE staff with a quality assurance role work closely with NICE staff from the health technologies team to agree the approach to take.
A guideline committee cannot usually publish its own recommendations on health technologies covered by published or in development health technologies guidance. In rare cases, technology appraisal guidance will be updated in the guideline (see the section on updating technology appraisal guidance in a guideline).
Technology appraisal being developed or updated alongside the guideline
When a technology appraisal is developed at the same time as a related NICE guideline, development should ideally be coordinated so that the appraisal recommendations are published in time for a link to be included in the consultation draft of the guideline. This is not always possible (for example, if the technology has not yet received a marketing authorisation). In this case, the guideline consultation draft should link to the appraisal consultation document or final appraisal determination. If guideline committee members wish to comment on the appraisal, they do this through the developer (see the NICE technology appraisal process guide).
The guideline committee chair and the developer may attend relevant appraisal committee meetings as advisers, but do not take part in the formal decision-making.
Updating technology appraisal guidance in a guideline
If there is new evidence for an existing NICE technology appraisal, it can be updated within the context of a guideline, as part of guideline development.
See our methods and process guides for more information on how NICE technology appraisals are developed:
These guides are being reviewed, and an updated version will publish in early 2022.
Early planning is essential to identify how the guideline developer will update technology appraisal guidance within a guideline. The developer should consider whether there are any data not in the public domain that are likely to be useful. If so, they should call for evidence from registered stakeholders, using the procedures described in the appendix on call for evidence and expert witnesses.
If there is significant new evidence or a change in costs since the technology appraisal guidance was published, the developer assesses cost effectiveness (performs an economic analysis) to determine whether a change in the recommendations is appropriate. In exceptional circumstances, it may not be clear that an economic analysis is needed until the evidence is reviewed and discussed by the committee. Nevertheless, the developer should start planning for any economic analysis at an early stage. The intended approach to cost-effectiveness (economic) analysis for technology appraisal updates should be included in the economic plan and discussed with the committee and a member of NICE staff with responsibility for quality assurance.
The approach should follow the principles described in the chapter on incorporating economic evaluation and should be similar to that used in the technology appraisal. Any differences must be justified by changes in the evidence base or the decision context (for example, a broader range of comparators in the guideline).
The developer may sometimes consider that cost effectiveness can best be assessed by modifying or building on the architecture of an existing economic analysis from the technology appraisal. If so, this should be discussed with a member of NICE staff with responsibility for quality assurance during development of the economic plan.
New technology appraisal referral during development of the guideline
When a new related technology appraisal is referred after the guideline has started development, and will be developed alongside the guideline, NICE's technology appraisals team informs the developer and NICE staff with responsibility for guideline quality assurance.
Referring to technology appraisals in recommendations
When related technology appraisal guidance is identified, the usual approach is for the guideline to make a recommendation to follow the technology appraisal recommendations. This recommendation should link to the relevant guidance pages. If needed, a brief explanation can be included in the guideline recommendation, for example, if it covers the sequencing of treatments recommended in technology appraisals. Any explanation needs to be agreed with the technology appraisals team at NICE.
In rare cases, technology appraisal recommendations may be included in the guideline, for example, if this is essential for readability or there is a need to highlight specific recommendations.
Sometimes a guideline covers a medicine for which there is technology appraisal guidance, but for a different population or indication (condition). In these cases, the committee developing the guideline recommendation should assess evidence of effectiveness using methods described in this manual. The guideline recommendations may be different from the technology appraisal recommendations if there is evidence of differing safety or effectiveness for the population or indications covered by the guideline.
8.4 Guidance from other developers
Sometimes relevant guidelines published by organisations other than NICE are identified in the search for evidence and considered appropriate for inclusion in the evidence base. Guidelines accredited by NICE are not subject to further appraisal of the guideline development process because this has already been assessed by NICE. However, the evidence reviews in the guideline will still need to be critically appraised (using checklists in the appendix on appraisal checklists, evidence tables, GRADE and economic profiles) to ensure that the quality of the evidence is appropriate for deriving NICE recommendations. Intellectual property issues need to be considered when using content from other organisations.
Published guidelines not accredited by NICE are assessed for quality using the AGREE II instrument or the AGREE global rating scale instrument. There is no cut‑off point for accepting or rejecting a guideline, and each committee needs to set its own parameters. These should be documented in the methods of the guideline, and a summary of the assessment included in the evidence review. The full results of the assessment should be presented with the guideline.
Reviews of evidence from guidelines that cover review questions being addressed by the committee may be considered as evidence if they:
-
are assessed as being of high quality using the appropriate methodology checklist (see the appendix on appraisal checklists, evidence tables, GRADE and economic profiles)
-
are accompanied by a GRADE table, GRADE-CERQual table or evidence statement and evidence tables
-
are assessed as being sufficiently up to date
-
do not have any intellectual property restrictions that would make it impossible to follow NICE's normal guideline development process.
If using evidence from published guidelines, the committee should create its own evidence summaries or statements (see the section on summarising evidence in the chapter on reviewing evidence). Evidence tables from guidelines published by other organisations should be referenced with a direct link to the source website or a full reference of the published document. The committee should formulate its own recommendations, taking into consideration the whole body of evidence.
Recommendations from guidelines published by another organisation should not be quoted or linked to, unless the guideline has been accredited by NICE and the evidence reviews have been critically appraised to verify quality.