gms | German Medical Science

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.