Healthy Skepticism Library item: 9831

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Journal Article

Fahey T.
Transparency in NICE: Construction and assumptions of models should be explicit
BMJ 2007 Apr 21; 334:(7598):814
http://www.bmj.com/cgi/content/full/334/7598/814

Abstract:

The National Institute for health and Clinical Excellence (NICE) uses Markov modelling, a form of decision analysis that models the effectiveness and cost effectiveness of drugs or other medical interventions in a cohort of patients over time.1 2 Construction of a Markov model relies on judgments of the likely outcomes of drug treatment, including benefits and harms.

I was asked to comment on the updated hypertension guidelines produced by NICE and the British Hypertension Society (BHS) on behalf of the Royal College of General Practitioners as part of the consultation process in spring 2006. Drug treatment for hypertension is a controversial area as guideline recommendations between the United States and the United Kingdom differ in the interpretation of recent randomised trials comparing newer and older antihypertensive agents.3

My comments related to the transparency of the Markov assumptions, including preferential modelling of diabetes as an adverse health state, failure . . .