National Institiue for Health and Clinical Excellence

Annual Review - 2012/2013

Speeding up the uptake of effective diagnostic technologies

NICE evaluates innovative medical diagnostic technologies to ensure clinically and cost effective tests are adopted quickly and consistently by the NHS.

Our diagnostics guidance is based on recommendations made by the independent Diagnostics Advisory Committee (DAC).

The diagnostics evaluated consist of a range of measurements and tests that are used to evaluate a patient’s condition. These include:

  • physiological measurements
  • laboratory tests and pathology tests
  • imaging tests
  • endoscopy

Having been fully established last year, NICE has since gone on to produce guidance on several products.

In August 2012, we published guidance on the SonoVue (sulphur hexafluoride microbubbles) contrast agent for contrast-enhanced ultrasound of the liver.

Ultrasound scanning, along with other imaging technologies, is important in diagnosing and planning treatment for many patients with liver disease. NICE found SonoVue to be both clinically and cost effective in diagnosing damage to the liver.

An important potential benefit of SonoVue is that it can be carried out at the same appointment as the initial ultrasound scan. This minimises any delay to diagnosis and subsequent treatment, which has the associated benefit of helping reduce anxiety among patients and their families.

In December 2012, we published guidance on Adjunctive colposcopy technologies (DySIS and the Niris Imaging System) for the examination of the uterine cervix. DySIS is digital image analysing system combined with a colposcope, which aims to improve diagnostic accuracy in the diagnosis of cervical cancer.

The guidance supports the technology as a cost-effective intervention for examining the uterine cervix in women referred for colposcopy.

Listen to a podcast with Dr Pierre Martin-Hirsch, specialist committee member for the DAC, to hear more about the equipment, and the cost implications of using the technology.

Monitoring patients under general anaesthetic

In November 2012, NICE published guidance on three EEG-based depth of anaesthesia monitors.

General anaesthesia is a reversible state of controlled unconsciousness, commonly used in patients during surgery to prevent awareness, recall, distress and movement.

The way that patients respond to anaesthetics can vary, and occasionally complications can arise, when inadequate or excessively deep levels of anaesthesia are administered. This can have severe consequences, including post-traumatic stress disorder and an increase in the incidence of stroke and heart attack.

Depth of anaesthesia monitors are designed to indicate the patient's response to anaesthetic drugs during surgery, to help avoid inadequate or excessively deep levels of anaesthesia.

NICE examined the evidence on three depth of amnesia monitors – Bispectral Index (BIS, Covidien), E-Entropy (GE Healthcare) and Narcotrend-Compact M (MT MonitorTechnik). The monitors aim to help the anaesthetist tailor the dose of anaesthetic used to the individual patient and consequently, lower the patient’s risk of adverse outcomes from anaesthesia.

Having reviewed the evidence, NICE recommended the use of the monitors as options in patients receiving total intravenous anaesthesia, and in patients who are considered at higher risk of adverse outcomes during any type of general anaesthesia.

Having been fully established last year, the programme has since gone on to produce guidance on several products

Dr David Smith discusses anaesthesia monitors