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Recommendations must better reflect societal values and preferences
The National Institute for Health and Care Excellence (NICE) develops healthcare guidance for the NHS, aiming to provide “the best care for patients, while ensuring value for the taxpayer.”1 Restricting access to effective healthcare on economic grounds is always controversial, and guideline authorities differ considerably in how they incorporate economic evidence into recommendations.2
NICE has been at the forefront of developing methods for economic evaluation,3 but recent recommendations have led to conflict with clinicians. For example, when draft aneurysm guidance proposed limiting access to new minimally invasive treatments on cost effectiveness grounds, clinical opposition resulted in NICE over-ruling its advisory committee.4 NICE’s rejection of graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome has been challenged by many specialists.5 These controversies may be the result of
### What you need to know
In venous thromboembolism, a blood clot usually forms in the deep veins of the legs or pelvis. This is known as deep vein thrombosis, and the blood clot can dislodge from these sites, resulting in pulmonary embolism.
In 2020, the National Institute for Health and Care Excellence (NICE) first published guidance on the diagnosis and management of venous thromboembolic disease.1 Since then, new evidence has emerged which indicates that people with covid-19 have a higher risk of developing venous thromboembolism and elevated D-dimer levels, and that this risk increased with severity of covid-19 infection. In the 2021 British Thoracic Society guidelines on venous thromboembolism in patients with covid-19, one meta-analysis of 49 studies reported an incidence of venous thromboembolism of 17% in people with covid-19, and that the incidence was higher in patients in intensive care (28%) compared with those on a medical ward (7%).2 D-dimer, a protein fragment that ca
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