Comparison of methodologies

National Institute for Clinical Excellence (NICE)
Scottish Intercollegiate Guidelines Network (SIGN)
Comparison of methodologies

Senior staff from the NICE guideline directorate and SIGN meet quarterly to discuss items of common interest and to identify areas where sharing of information is mutually beneficial. During 2004 they were asked by the Chairmen and Chief Executives of NICE and NHS Quality Improvement Scotland (NHS QIS) to produce a short paper to identify where variations occur in the two approaches to guideline development.

This request coincided with work already underway to compare the methodologies used to generate the forthcoming lung cancer guidelines produced by both NICE and SIGN (to be published in February 2005). This summary draws on this work. Only areas of material difference are highlighted; many of the processes and methodological documentation used are the same or very similar. NICE and SIGN guidelines additionally highlight connections to appropriate policies, clinical standards, audits and service organisational issues (such as Managed Clinical Networks in Scotland) for England & Wales and Scotland respectively.

Four areas of significant difference were identified.

Topic selection processes

NICE	SIGN
NICE formally referred topics by the Department of Health and the Welsh Assembly but NICE is involved in various stages of topic identification and selection	Healthcare professionals and members of the public suggest topics to SIGN. SIGN Council and its subgroups recommend the proposed programme to NHS QIS who give final approval.

Evaluation of evidence

NICE	SIGN
Trained systematic reviewers at the National Coordinating Centres commissioned by NICE evaluate the evidence in discussion with clinical experts.	Guideline development group (GDG) members are given training by SIGN in critical appraisal and assess the evidence themselves.

Economics

NICE	SIGN
NICE aim to ensure health economists are core members of the technical team in the GDG; include cost effectiveness analysis in all recommendations and undertake a cost impact analysis for each guideline.	SIGN do not undertake economic analysis, but include any relevant high quality published economic evaluation in the evidence base. SIGN guidelines include commentary on the resource implications of recommendations if these are significant.

Stakeholder consultation

NICE	SIGN
NICE has three stakeholder consultations, review by independent experts when appropriate and independent review by the Guideline Review Panel.	SIGN has one National meeting which anyone can attend, peer review by independent experts and lay reviewers and a final independent review by the SIGN Editorial Group.

Full details of the methodologies used by NICE and SIGN area available in the NICE Guidelines Technical Manual and SIGN 50.