gms | German Medical Science

G-I-N Conference 2012

Guidelines International Network

22.08 - 25.08.2012, Berlin

Modelling of clinical pathways to assess cost-effectiveness in NICE guidelines: impact on stakeholder views of the importance of potential update topics

Meeting Abstract

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  • C. Crossan - Health Economics Research Group, Brunel University, London, United Kingdom
  • M. Westby - National Clinical Guideline Centre, Royal College of Physicians, London, United Kingdom
  • J. Lord - Health Economics Research Group, Brunel University, London, United Kingdom

Guidelines International Network. G-I-N Conference 2012. Berlin, 22.-25.08.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocO69

doi: 10.3205/12gin101, urn:nbn:de:0183-12gin1011

Published: July 10, 2012

© 2012 Crossan et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: NICE clinical guidelines make recommendations on effective and cost-effective care for people with specific diseases. Currently, estimates of cost-effectiveness are based on modelling selected recommendations within the care pathway. Modelling whole pathways of care may have advantages over this partial approach.

Objectives: The MAPGuide project aims to test the feasibility and usefulness of whole pathway models for assessing cost-effectiveness in NICE guidelines.

Methods: For two published NICE guidelines (Prostate Cancer and Atrial Fibrillation), we used patient-level simulation to model the pathway and disease progression and to estimate the cost-effectiveness of guideline recommendations. Following a routine review of the guidelines by NICE, we identified 8–10 potential changes to each guideline. We surveyed guideline stakeholders to assess their initial views on the importance of these topics for inclusion in an update of the guidelines. The modelling teams then estimated the cost-effectiveness of the suggested update topics. A second survey provided participants with a summary of the model methods and results and they were asked to re-assess the importance of each potential update topic.

Results: We will report on the feasibility of developing whole pathway models and present stakeholder views on the model methods, results and impact on their perceptions of the importance of update topics.

Discussion-Implications for guideline developers/users: Whole pathway modelling is feasible and may be an efficient means of expanding cost-effectiveness assessment across a care pathway in guidelines, but it is time-consuming and costly and it is difficult to present model results to stakeholders in a clear and understandable format.