NICE and Cochrane: working together

Brief background
The National Institute for Health and Clinical Excellence (NICE) produces guidelines for health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. The guidelines are produced by independent advisory committees comprising people with expertise in systematic reviews and health economics analyses, clinicians, and lay members who have an interest in the topic.

Cochrane produces Cochrane systematic reviews that are recognised as being high quality in evidence-based healthcare. Systematic reviews are a key component of guideline development. Typically, when developing NICE guidelines, there are 15 to 20 clinical questions, which are addressed by systematic reviews. These reviews are usually carried out ‘in-house’ by NICE guideline development teams who also routinely search for and use existing relevant, high-quality and up-to-date systematic reviews to inform the development of these.

Going further together
In September 2021, NICE and Cochrane signed a collaborative agreement to enable better use of Cochrane Reviews and Cochrane expertise in NICE guidelines.

This agreement also supports NICE’s strategy for 2021–2026, which aims to have dynamic, living guideline recommendations by creating and maintaining up-to-date guidance that integrates the latest evidence and technologies in a useful and usable format. NICE is transitioning from producing full guidelines to a more modular, living approach of recommendations or clusters of recommendations enabling rapid updates and a more efficient process.

Collaborating with Cochrane will help NICE achieve this as the organisations align priorities and answer important questions relevant to health and social care. The collaboration will also enhance efficiencies by reducing the number of duplicated surveillance and evidence-reviewing activities.

Supporting the partnership
Collaboration between two big organisations can be challenging; however, the following arrangements have made the process easier.

- Creating dedicated resources

• In January 2022, NICE appointed dedicated technical resources to support and embed collaborative approaches within NICE’s guideline development processes. Current efforts are focused on aligning prioritisation of reviewing activities where feasible.
• A NICE-Cochrane steering group discusses ways of collaborating and removes barriers that may be limiting collaborative efforts. The steering group includes key people from both organisations who are aware of, and can influence, processes related to the prioritisation and development of evidence reviews.

- Clear processes

• NICE and Cochrane developed a guideline support document for guideline developers that outlines the operational processes and considerations for using Cochrane reviews. It includes principles of fair use, copyright permissions and appropriate citation, and ways of developing new or updating existing Cochrane reviews in collaboration with Cochrane review authors.
• The guideline support document also outlines agreed communication routes between NICE and Cochrane. This supports NICE guideline development teams and Cochrane review groups/networks to begin collaboration at any suitable stage of guideline development.

- Information sharing

• NICE and Cochrane are committed to sharing information that allows for alignment of priorities and to ensure that collaboration is successful.
• Technology is also a recognised enabler of more effective collaborative efforts and NICE and Cochrane are working towards using compatible evidence-reviewing platforms. This will enable easier and quicker file sharing, and the updating of evidence reviews when new evidence becomes available.

Persistent challenges
Despite these new arrangements, some challenges to working collaboratively remain. NICE timelines for development of an evidence review are typically quicker (roughly three to six weeks) and less flexible than the production timeline for a Cochrane review. There is a need to agree to timelines and editorial processes to ensure a Cochrane review can be considered in NICE guidelines.

Another challenge is the alignment of review questions, especially the outcomes component of the review questions. NICE may exclude Cochrane reviews when the outcomes selected in the Cochrane reviews differ from the outcomes selected for the NICE guideline. Work is being done to align the outcomes, especially in areas where core outcome sets have not yet been decided. Working together as early as possible will help to reduce duplication and enable better sharing of evidence.

Evaluating impact
Since September 2021, there have been two completed NICE and Cochrane collaborations, where the guideline developers and Cochrane review groups aligned priorities to produce a systematic review and the subsequent guideline update. In these examples, the Cochrane reviews informed 100% of the guideline update.
The two organisations are currently collaborating in a similar way on seven more guidelines. The resulting Cochrane reviews will address the scopes in at least a third of these guidelines. This means that the evidence from Cochrane reviews will have a direct impact on recommendations that will improve patient care.

The collaborations to date have reduced the duplication of efforts in developing evidence reviews while incorporating the topic expertise of Cochrane authors.

Key messages
There are clear mutual benefits to NICE and Cochrane working together, including reduced duplication of effort in evidence production and increased access to topic expertise early in the scoping stage of guideline development. We would like to continue building on this partnership so that collaboration between the two organisations becomes a routine part of systematic review production and guideline development, ensuring that evidence-reviewing efforts better inform health and care practice. This will contribute to NICE’s strategic ambition to provide dynamic living guidelines by focusing on topic areas that represent key priorities, ensuring that NICE maintains the most appropriate portfolio with the greatest impact on health.

Authors
Jean Masanyero-Bennie¹, Toby Lasserson², Therese Docherty³, Nichole Taske¹.

1. NICE

2. The Cochrane Collaboration

3. Cochrane UK

Disclaimer
The views expressed in this World EBHC Day Blog, as well as any errors or omissions, are the sole responsibility of the author and do not represent the views of the World EBHC Day Steering Committee, Official Partners or Sponsors; nor does it imply endorsement by the aforementioned parties.