Cochrane reviews inform UK national policy on disinvestment from ineffective interventions

Article type
Authors
Garner S1, Clarke M2, Somner J1, Clarke T2, Clarke T2, Miller C3, Hudson T3, Brown D3, Middleton C3, Chalkidou K3, Littlejohns P3
1R&D, NICE, London, UK
2UK Cochrane Centre, Oxford, UK
3R&D , NICE, London, UK
Abstract
Background: Rising healthcare costs and a thirst for innovation, coupled with the economic crisis, mean that healthcare systems around the world are under increasing pressure. Rather than ‘cutting costs’, the 21st century focus is on identifying ‘efficient’ ‘value for money’ strategies that are sustainable and equitable, and lead to improvements in the quality of care and, ultimately, patient outcomes. The National Institute for Health and Clinical Excellence (NICE) is responsible for providing national guidance on promoting good health and preventing and treating ill health in the UK. Objectives: In 2006, NICE commissioned the UK Cochrane Centre (UKCC) to produce quarterly reports of new or updated Cochrane reviews whose authors had concluded that an intervention should not be used or should only be used in research. These are used to identify potential disinvestment topics within the National Health Service. Methods: The UKCC checks the Implications for practice section in new and updated Cochrane reviews in each issue of The Cochrane Library, and in all Cochrane reviews once a year. It provides a list of reviews to NICE, where an evaluation is done to ascertain current usage of the intervention in the UK, identify existing NICE guidance or economic evaluations, estimate the financial implications and determine whether additional research is required. The evaluation is summarised and, from July 2010, will be available as a monthly report on the NICE website, through its NHS Evidence ‘quality and productivity’ portal. If appropriate, topics are also assessed for inclusion in the NICE guidance programme. Results: As of March 2010, more than 400 topics have been evaluated. Conclusions: Cochrane reviews, particularly those of established technologies, are an important source of potential topics for disinvestment to inform national policy and research.