Update to the National Institute of Health and Care Excellence (NICE) Guideline

The Project

NICE guidelines make evidence-based recommendations for health and care in England and Wales. They look at ways to promote and protect good health, prevent ill health, and improve the quality of care and services within the National Health Service (NHS). The NICE clinical guideline on Familial breast cancer (CG164) was published in 2013. Guidelines are regularly updated when new treatments become available, or new evidence may mean changes in practice. The Familial breast cancer guideline was updated in August 2015.

SCHE worked with the National Collaborating Centre for Cancer and NICE to provide the health economics expertise, reviews, modelling and analysis to support the update of the NICE guideline.


The Evaluation

SCHE provided the health economic evidence required to base recommendations for testing, screening and care of people affected by a family history of breast cancer. Rigorous systematic reviews of economic evidence on different topics relating to the screening, diagnosis and management of patients with a familial history of breast cancer were undertaken to inform recommendations. A complex decision analytical model was developed to investigate the cost-effectiveness of genetic testing for patients with a familial history of breast cancer with and without a personal history and patients with no living relative to test at different ages. Furthermore, SCHE adapted an existing model investigating the cost-effectiveness of mammography and MRI screening for the population in question which informed recommendations on frequency and modality of screening for people at risk.


What was the outcome of this project?

This work has resulted in recommendations which have been implemented across the UK NHS.  Thousands of people will have access to enhanced preventative care based on cost-effective solutions to improve health outcomes, resulting in fundamental, immediate and direct changes to clinical practice. There has been a well-documented impact of this research for patient benefit and it is informing public debates in the UK and internationally. 

Scotland’s Health Minister confirmed the intention to extend genetic testing to the recommendation directly underpinned by our research contained in the NICE guidance, with Wales and Northern Ireland expected to follow suit. Our research contribution has also brought the UK in line with care offered to similar international patient populations, thus providing a demonstrable achievement in reducing international variations in treatment and care and ultimately patient outcomes.