Procedures of Limited Clinical Effectiveness Phase 1
Consolidation and repository of the existing evidence-base
Meeyin Lam, Public Health Trainee
Jennie Mussard, Assistant Director (PCT Intelligence)
This report was produced with the support of the London Health Observatory team, which is part of the Clinical Health Intelligence Directorate, CSL.
Key Points

This table includes a list of 70 potentially avoidable procedures under 41 main procedure groupings, based on the master list provided in the DFI report. The
DFI codes have been included.

A total of 26 of the main procedure groups are listed by at least five London sectors (14 procedures), have NICE guidance (16 procedures) or both (4
procedures). This suggests that there is a reasonable evidence-base, or a strong foundation for consensus, for developing pan-London referral guidance.
These are shaded blue or green.

The remaining 15 procedures are listed by less than five London sectors and do not have NICE guidance, indicating that more extensive evidence appraisal
and clinical consultation is needed.

Three procedures have been identified as having higher potential or stretch savings across London as a whole AND are on less than five London sector lists.
These procedures are a priority for further evidence appraisal, as the savings may be greater. These are shaded yellow.

The Appendix reviews an additional list of procedures that are not included in commissioners’ list- and include some outpatient procedures
1
Definition of rationale categories
-
Balance of clinical evidence: a planned procedure where evidence of clinical- and/or cost-effectiveness is either absent, or too weak for reasonable
conclusions about efficacy and long term benefits/harms to be reached
Cosmetic: a largely cosmetic procedure
Clinical criteria: a procedure where evidence of clinical- and/or cost-effectiveness exists but only in limited cases or when a person meets certain clinical
criteria or thresholds
Cost-effective alternative: a procedure which is clinically effective but more cost-effective alternatives should be tried first
Cancelled procedures
Local reviews of evidence and referral guidance – London
ETR: Exceptional treatment reviews: procedures. Reviewer PCT listed in brackets
INEL: Inner North East London Low Priority/Excluded Restricted Procedures 2010-2011 (draft list)
NCL: North Central London Policy for Low Priority Treatments (draft 2)
NWL Policy: North West London’s ‘Interventions Not Normally Funded’ Policy. Includes hierarchy of evidence and grading of recommendation (A -D).
A: Based on evidence from systematic reviews, meta-analysis of randomised controlled trials or at least one randomised controlled trial
B: Based on evidence from at least one controlled study without randomisation or at least one other type of quasi experimental study
C: Based on evidence from non experimental descriptive studies, such as comparative studies, correlation studies and case control studies
D: Directly based on evidence from expert committee reports or opinions and/or clinical experience of respected authorities or extrapolated from hierarchy
evidence from above
ONEL: Outer North East London Procedures of Limited Clinical Effectiveness. April 2010 (draft policy). Provides evidence review. Does not include most
cosmetic procedures.
SEL: South East London Exceptional Treatments Commissioning Policy (not including dental and orthodontic)
Section 1 treatments require review and approval by the relevant group and prior funding agreed
Section 2 treatments do not require prior agreement; however they must be notified to the Care Trust / PCT along with information about details of how
the access criteria were met.
SWL: South West London Effective Commissioning Initiative 2009/10. Provides evidence review.
Local reviews of evidence and referral guidance – outside London
C&M: Draft Cheshire and Merseyside Prior Approval Scheme, Incorporating Procedures of Lower Clinical Priority. A review and compilation of the policies of the
8 PCTs in Cheshire and Merseyside. Criteria were also informed by a review undertaken by the South West London Public Health Network on behalf of 5
PCTs in London and the London Health Observatory. Criteria have been classified as either ‘not contentious’ as all current policies are very similar or
‘requires discussion to agree criteria’ if there is significant variation between policies.
2
Brighton: NHS Brighton and Hove PCT policies - Procedures which require prior approval from the PCT
Evidence reviews and guidance in green text have been referenced by others (including Dr Foster Intelligence), but not cross-checked for this project. They may
have reviews of evidence.
- Berkshire NHS Priorities Website
- Brent PCT
- Hampshire & Isle of Wight PCTs (South Central Priorities Committee) Policy
- Norfolk Policy for Low Priority Procedures and Thresholds
- Oxfordshire PCT
- Suffolk Low Priority Treatment Policy
- Waltham Forest Exceptional Treatments Policy 2008
- West Essex PCT Surgical Threshold Policy
- West Essex PCT Priorities Policy
- West Sussex PCT Low Priorities Procedures and Other Procedures and Restrictions
- Western Cheshire
- Westminster PCT, 2007, Low priority procedures policy
Stratification of areas for further work
Procedures have been highlighted in the table in the following colours:
BLUE: all or most (5/6) London sectors have referral guidance for the procedure, though they may not be identical, and/or there is NICE guidance
YELLOW: the procedure has been identified to have a higher potential or stretch saving level across London as a whole (this may vary for different sectors and
PCTs). The levels of saving were identified by Dr Foster Intelligence.
GREEN: procedure meets both of the above criteria
WHITE: Four or less London sectors have referral guidance for the procedure AND there is no relevant NICE guidance
Notes
‘London at top national quartile’ in the comments section refers to DFI’s ‘stretch savings’ analysis. Eight procedures have no ‘stretch’ savings using the measure,
as London is already at top national quartile performance or better. However, this performance level may not reflect actual need.
3
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
Comments
British Association Oral and Maxillofacial
Surgeons. Referral guidelines. Apical surgery.
Previously available at
http://www.baoms.org.uk/CDROM/guidelines/Apical%20surgery.pdf
(accessed 3rd October 2007)
NWL Policy (D)
NWL with
exceptions
London at top
national
quartile
Balance of clinical evidence
Apicectomy
A01
Balance of
clinical
evidence
NCL1
Royal College of Surgeons of England.
Guidelines for surgical endodontics.
http://www.rcseng.ac.uk/fds/clinical_guidelines/do
cuments/surg_end_guideline.pdf (accessed 1st
Oct 2007)
Autologous
chondrocyte
implantation
A02
Balance of
clinical
evidence
NICE Technology appraisal TA89
C&M criteria
London at top
national
quartile
Western
Cheshire
(Blue)
Injections and
fusion for back
pain
A03
Balance of
clinical
evidence
Gibson JNA, Waddell G. Surgical interventions for lumbar disc
prolapse. Cochrane Database of Systematic Reviews 2007, Issue 2.
Ibrahim T; Tleyjeh IM; Gabbar O. Surgical versus non-surgical
treatment of chronic low back pain: a meta-analysis of randomised
trials. International Orthopaedics, February 2008, vol./is. 32/1(10713), 0341-2695
NICE Clinical Guidance CG 88 (published May
2009)
ONEL
SWL
ONEL2
3
SWL critieria
Brighton4
Suffolk
Mirza SK; Deyo RA Systematic review of randomized trials
comparing lumbar fusion surgery to non-operative care for treatment
of chronic back pain. Spine, April 2007, vol./is. 32/7(816-23), 15281159
Rivero-Arias O, Campbell H, Gray A et al. Surgical stabilisation of
the spine compared with a programme of intensive rehabilitation for
the management of patients with chronic low back pain: cost utility
1
Minor oral surgery for retained roots
Spinal surgery for non-acute lumbar conditions
3
Discectomy for lumbar disc prolapse
4
Vertebroplasty
2
4
Also see
listing for
Lumbar disc
prolapse
(A09)
(Blue)
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
NICE, “Press release – guidance on hearing
aids”, 2000
ETR (Tower
Hamlets)5
Hampshire &
Isle of Wight
PCTs
analysis based on a randomised controlled trial. BMJ. 2005 May
28;330(7502):1239
Van Tulder M, Koes B, Seitsalo S, Malmivaara A. Outcome of
invasive treatment modalities on back pain and sciatica: an
evidence-based review. Volume 15, Supplement 1 / January, 2006
Can be purchased from
http://www.springerlink.com/content/718525118748783t/fulltext.pdf
For discectomy:
Butterman GR. Treatment of lumbar disc herniation: epidural steroid
injection compared to discectomy. J Bone and Joint Surgery 2004;
86-a: 670-9
Greenfield K, Nelson RJ et al. Microdiscectomy and conservative
treatment for lumbar disc herniation with back pain and sciatica: a
randomized clinical trial. Proceedings of the International Society for
the Study of the Lumbar Spine, 2003: 245
Hoffman RM, Wheeler KJ, Deyo RA. Surgery for herniated lumbar
discs: a literature synthesis. J Gen Int Med 1993; 8: 487-96
Malter AD, Larson EB et al. Cost effectiveness of lumbar discectomy
for the treatment of herniated invertebral disc. Spine 1996; 21: 104855
Weber H. Lumbar disc herniation. A controlled, prospective study
with ten years of observation. Spine 1983 8(2): 131-40
Weinstein JN, Torteson TD, Lurie JD et al. Surgical vs Nonoperative
Treatment for Lumbar Disk Herniation. JAMA 2006 296
Bilateral bone
anchored
hearing aid
(BAHA)
A04
Balance of
clinical
evidence
Tower Hamlets provided the following sources (to support funding?)
Dutt, S, et al, Patient satisfaction with bilateral bone-anchored
hearing aids: the Birmingham experience, J Laryngol Otol, 2002,
116, 37-45, p 41.
Snik, A, et al, Candidacy for the bone-anchored hearing aid, Audiol
Neurotol, 2004, 9, 190-96, p196.
5
6
The effectiveness of bone anchored hearing aids (BAHAs) for a patient who has profound mixed bilateral hearing loss
Minutes of meeting of exceptional funding panel 19th December 2005, EP263 Funding for Bone-Anchored Hearing Aid, p4
5
South
Gloucestershire PCT6
Comments
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Snik, A, et al, Consensus statements on the BAHA system: where
do we stand at present?, Ann Otol, Rhinol Laryngol, 2005, Dec, 114,
12, 2-12, p7.
Referral
guidance
Comments
Croydon list
Bedfordshire
and
Hertfordshire7
REFER, Department of Health Research Findings Register, The use
of bone-anchored hearing aids, REFER Summary, 2001, 1-3, p2.
http://www.refer.nhs.uk/ViewRecord.asp?id=505
Doncaster
Primary Care
Trust8
Proops, D, The evidence base for aural rehabilitation with the boneanchored hearing aid, J Laryngol Otol, 2002, 28, p1.
Dutt, S, et al, The Glasgow Benefit Inventory in the evaluation of
patient satisfaction with the bone anchored hearing aid: quality of life
issues, J Laryngol Otol, 2002, June, 116, Supplement 28, 7-14, p10.
Dilatation and
curettage
A05
Balance of
clinical
evidence
Coulter A, Kelland J, Long A. The management of menorrhagia.
Effective Health Care Bulletin 1995; (9).
NICE Clinical Guideline on heavy menstrual
bleeding CG44
Emanuel MH, Wamsteker K, Lammes FB. Is dilatation and curettage
obsolete for diagnosing intrauterine disorders in premenopausal
patients with persistent abnormal uterine bleeding? Acta Obstet
Gynecol Scand 1997; 76: 65.
Royal College of Obstetricians and
Gynaecologists. Management of Menorrhagia in
Secondary Care. 1999
BMJ Clinical Evidence: Menorrhagia. Sept 06.
ONEL
ONEL
NWL Policy (D)
NWL with
exceptions
SEL criteria/
notification
NHS Institute for Innovation and Improvement.
NHS Better Care, Better Value Indicators:
Surgical thresholds indicators. 10 October 2007
At http://www.productivity.nhs.uk/Definitions.aspx
Accessed 26.3.08
INEL
SWL does
not include
London at top
national
quartile
(Blue)
NCL
C&M (req
discussion)
Brighton
Croydon list
Berkshire
West Essex
Ganglia
7
8
A06
Balance of
clinical
evidence
Vroon P, Scholten RJ, van Weert HCPM. Interventions for ganglion
cysts in adults (Protocol). Cochrane Database of Systematic
Reviews 2005, Issue 2. Available at:
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/C
D005327/pdf_fs.html [Accessed 2nd Oct 2007]
INTERIM Priorities Forum, Bone anchored hearing aids (BAHAs), Forum Statement 30, 2006, p 1.
Effective and appropriate healthcare, 2006, Bone anchored hearing aids, 6.1. http://www.doncasterpct.nhs.uk/yourhealth.asp?ArticleID=100029
6
NWL Policy (A)
ONEL
NWL with
exceptions
SWL does not
include
SEL
notification
(Blue)
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Burke FD, Melikyan EY, Bradley MJ, Dias JJ. Primary care referral
protocol for wrist ganglia. Postgrad Med J 2003 79:329-331
Referral
guidance
Comments
ONEL
INEL
Bandolier. Wrist ganglia. Webpage. [Cited 19th Sept 2007].
Available at:
http://www.jr2.ox.ac.uk/bandolier/booth/miscellaneous/wristgang.htm
l
NCL
Revised
Croydon list
Wildin C, Dias J, Heras-Palou C, Bradley M, Burke FD. Trends in
elective hand surgery referrals from primary care. Annals of The
Royal College of Surgeons of England 2006; 88 [6]: 543-546
Dias J, Buch K. Palmar wrist ganglion: does intervention improve
outcome? A prospective study of the natural history and patientreported treatment outcomes. J Hand Surg (Br) 2003;2: 172-6.
Grommets
A07
Balance of
clinical
evidence
Langton Hewer CD, McDonald S, Nunez DA. Grommets (ventilation
tubes) for recurrent acute otitis media in children. Cochrane
Database of Systematic Reviews 2004, Issue 2. Available at:
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/C
D004741/pdf_fs.html [Accessed 2nd Oct 2007]
Lous J, Burton MJ, Felding JU, Ovesen T, Rovers MM, Williamson I.
Grommets (ventilation tubes) for hearing loss associated with otitis
media with effusion in children. Cochrane Database of Systematic
Reviews 2005, Issue 1. Available at:
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/C
D001801/pdf_fs.html [Accessed 2nd Oct 2007]
NICE Clinical Guideline on surgical management
of otitis media with effusion CG60
SIGN Guideline 66 (2003) Diagnosis and
management of childhood Otitis Media in Primary
Care
NHS Institute for Innovation and Improvement.
NHS Better Care, Better Value Indicators:
Surgical thresholds indicators. 10 October 2007
At http://www.productivity.nhs.uk/Definitions.aspx
Accessed 26.3.08
Centre for Reviews and Dissemination. The
treatment of persistent glue ear in children. 1992.
http://www.york.ac.uk/inst/crd/projects/glueear.ht
m
Maw, R., Wilks, J., Harvey, I. et al (1999) Early surgery compared
with watchful waiting for glue ear and effect on language
development in preschool children: a randomised trial [published
erratum appears in Lancet 1999 Oct 16;354(9187):1392]. Lancet
353(9157), 960-963
Oomen k et al (2005) Effect of adenotonsillectomy on middle ear
status in children. Laryngoscope Apr;115(4):731-4
Paradise JL (2005) Developmental outcomes after early or delayed
insertion of typanostomy tubes. NEJM (353);6:576-589
Rosenfeld et al (2004) Clinical Practice Guideline: Otitis Media with
Effusion. Otolaryngology – Head and Neck Surgery (130);5;s95s118
Williamson I. Otitis media with effusion. Treatment. Surgery
(ventilation tubes, adenoidectomy, or both). BMJ Clinical Evidence
2006. Available
7
NWL Policy (A)
NWL
ONEL
SEL with
exceptions
SWL
ONEL
INEL
SWL criteria
NCL
C&M criteria
(req
discussion)
West Essex
Also see
adenoidectomy
(Blue)
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
Comments
http://clinicalevidence.bmj.com/ceweb/about/index.jsp [Accessed
19th Sept 2007]
Grommets
(adults)
Yung MW, Arasaratnam R. Adult-onset otitis media with effusion:
results following ventilation tube insertion. J Laryngol Otol. 2001
Nov;115(11):874-8
NHS Institute for Innovation and Improvement.
NHS Better Care, Better Value Indicators:
Surgical thresholds indicators. 10 October 2007
At http://www.productivity.nhs.uk/Definitions.aspx
Accessed 26.3.08
Montandon P, Guillemin P, Häusler R. Prevention of vertigo in
Ménière's syndrome by means of transtympanic ventilation tubes.
ORL J Otorhinolaryngol Relat Spec. 1988;50(6):377-81.
Adenoidectomy for otitis
media in
children
Lous J, Burton MJ, Felding J, Ovesen T, Rovers M, Williamson I.
Grommets (ventilation tubes) for hearing loss associated with otitis
media with effusion in children. Cochrane Database of Systematic
Reviews 2005, Issue 1.Art.No.:CD001801.DOI:10.1002/
14651858.CD001801.pub2.
NICE Guidance CG60 (February 2008)
Rosenfeld et al (2004) Clinical Practice Guideline: Otitis Media with
Effusion. Otolaryngology – Head and Neck Surgery (130);5;s95s118
Brighton
ONEL
SEL criteria/
notification
ONEL
May be
included in
Grommets
guidance
INEL
(Blue)
NCL
West Essex
Oomen k et al (2005) Effect of adenotonsillectomy on middle ear
status in children. Laryngoscope Apr;115(4):731-4
Williamson I. Otitis media with effusion. Treatment. Surgery
(ventilation tubes, adenoidectomy, or both). BMJ Clinical Evidence
2006. Available
http://clinicalevidence.bmj.com/ceweb/about/index.jsp [Accessed
19th Sept 2007]
Paradise JL (2005) Developmental outcomes after early or delayed
insertion of typanostomy tubes. NEJM (353);6:576-589
Knee washout
A08
Balance of
clinical
evidence
NICE IPG230 Arthroscopic knee washout, with or
without debridement, for the treatment of
osteoarthritis. Aug 2007
NICE CG59 The care and management of
osteoarthritis in adults. Feb 2008
Clinical criteria
– NICE restrict
to pts with
mechanical
locking. NICE
have only
commented
on use in OA,
not other
conditions eg
RA
(Green)
8
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Lumbar disc
prolapse
A09
Balance of
clinical
evidence
Surgical Disorders of the Thoracic and Lumbar Spine: A Guide For
Neurologists- Nitin Patel - J Neurol Neurosurg Psychiatry
2002;73:i42-i48 doi:10.1136/jnnp.73.suppl_1.i42
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
Comments
ONEL
ONEL9
Also see
listing for
Injections and
fusion for back
pain (A03)
Revised
Croydon list
Cochrane review of surgery for lumbar disc prolapse and
degenerative lumbar spondylosis. Spine (Phila Pa 1976). 1999 Sep
1;24(17):1820-32. http://www.ncbi.nlm.nih.gov/pubmed/10488513
Spinal cord
stimulation10
A10
Balance of
clinical
evidence
McElveen WA. Postherpectic neuralgia. Emedicine review – last
updated in Sept. 2008. Available online at:
http://www.emedicine.com/neuro/topic317.htm#section~Treatment
NICE - Pain (chronic neuropathic or ischaemic) spinal cord stimulation. Issue date October 2008.
http://guidance.nice.org.uk/TA159
Kumar, K et al. Spinal cord stimulation versus conventional medical
management for neuropathic pain: a multicentre randomised
controlled trial in patients with failed back surgery syndrome. Pain.
2007; 132: 179-88.
NICE Technology Appraisal TA159 - Spinal cord
stimulation for chronic pain of neuropathic or
ischaemic origin. Issue date October 2008.
http://www.nice.org.uk/nicemedia/live/12082/4236
7/42367.pdf
Kumar K, Taylor RS, Jacques L, et al. The effects of spinal cord
stimulation in neuropathic pain are sustained: a 24-month follow-up
of the prospective randomized controlled multicenter trial of the
effectiveness of spinal cord stimulation. Neurosurgery.
2008;63(4):762-70.
Kemler MA, de Vet HC, Barendse GA, van den Wildenberg FA, van
Kleef M. Effect of spinal cord stimulation for chronic complex
regional pain syndrome Type I: five-year final follow-up of patients in
a randomized controlled trial. J Neurosurg. 2008; (2):292-8.
Manca A, Kumar K, Taylor RS, Jacques L, Eldabe S, Meglio M, et
al. Quality of life, resource consumption and costs of spinal cord
stimulation versus conventional medical management in neuropathic
pain patients with failed back surgery syndrome (PROCESS trial).
Eur J Pain. 2008;12(8):1047-58.
Mekhail NA, Aeschbach A, Stanton-Hicks M. Cost benefit analysis of
neurostimulation for chronic pain. Clin J Pain. 2004; 20(6):462-8.
Harke H, Gretenkort P, Ladleif HH, et al. Spinal Cord Stimulation in
9
Spinal surgery for non-acute lumbar conditions
ONEL categorises this under ‘Functional Electrical Stimulation’
10
9
ETR (Camden
PCT)
West Sussex
Original
Croydon list
NICE
recommends
SCC as
treatment
option with
clinical criteria
ONEL advise
to consider
costs of
different
systems
London at top
national
quartile
(Blue)
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
Comments
McKerrow W. Tonsillitis. Tonsillectomy versus antibiotics in children.
BMJ Clinical Evidence 2006. Available at:
http://clinicalevidence.bmj.com/ceweb/about/index.jsp [Accessed
19th Sept 2007]
Royal College of Paediatrics and Child Health.
Guidelines for good practice. Management of
acute and recurring sore throat and indications for
tonsillectomy. London: RCPCH; 2000
NWL Policy (D)
NWL with
exceptions
(Green)
Adenotonsillectomy for upper respiratory infections: evidence
based? Arch Dis Child 2005;90:19–25
Scottish Intercollegiate Guidance Network.
Management of sore throat and indications for
tonsillectomy. Edinburgh: SIGN guidance 34
(1999, reviewed 2005). Available at:
http://www.sign.ac.uk/guidelines/fulltext/34/index.
html [Accessed 19th Sept 2007]
Postherpetic Neuralgia and in Acute Herpes Zoster Pain. Anesth
Analg 2002;94:694-700.
Meglio M, Cioni B, Prezioso A, Talamonti G. Spinal cord stimulation
(SCS) in the treatment of postherpetic pain. Acta Neurochir Suppl
(Wien) 1989;46:65-6.
Taylor RS, Van Buyten JP, Buchser E. Spinal cord stimulation for
chronic back and leg pain and failed back surgery syndrome: a
systematic review and analysis of prognostic factors. Spine.
2005;30(1):152-60.
Cruccu G, Aziz TZ, Garcia-Larrea L, Hansson P, et al. EFNS
guidelines on neurostimulation therapy for neuropathic pain. Eur J
Neurol 2007;14(9):952-70.
Tonsillectomy
A11
Balance of
clinical
evidence
Burton MJ, Glasziou PP. Tonsillectomy or adeno-tonsillectomy
versus non-surgical treatment for chronic/recurrent acute tonsillitis.
Cochrane Database of Systematic Reviews 2009, Issue 1
Van Staaij et al. Adeno-tonsillectomy for upper respiratory infections:
evidence based? Arch Dis Child 2005; 90:19–25.
Paradise JL, Bluestone CD, Bachman RZ, et al. Efficacy of
tonsillectomy for recurrent throat infection in severely affected
children. Results of parallel randomized and nonrandomized clinical
trials. N Engl J Med 1984; 310: 674-83.
Cochrane Database of Systematic Reviews. Adeno-tonsillectomy for
obstructive sleep apnoea in children.
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/C
D003136/abstract.html
Raut VV, Yung MW. Peritonsillar abscess: the rationale for interval
tonsillectomy. Ear Nose Throat J. 2000; 79(3):206-9
Ryan, C.F. Sleep 9:An approach to treatment of obstructive sleep
apnoea hypopnoea syndrome including upper airway surgery.
10
ONEL
SWL
SEL with
exceptions
ONEL
INEL
SWL criteria
NCL
C&M criteria
(req
discussion)
Western
Cheshire
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
ONEL
SEL criteria/
notification
Thorax 2005; 60:595-604.
Trigger finger
(stenosing
tenosynovitis)
A12
Balance of
clinical
evidence
Peters-Veluthamaningal C, van der Windt DAWM, Winters JC,
Meyboom- de Jong B. Corticosteroid injection for trigger finger in
adults. Cochrane Database of Systematic Reviews 2009, Issue 1.
ONEL
Fleisch SB, Spindler KP, Lee DH (2007) Corticosteroid injections in
the treatment of trigger finger: a level I and II systematic review. J
Am Acad Ortop Surg. 2007 Mar;15(3):166-71
INEL
NCL
Marks MR, Gunther SF: Efficacy of cortisone injection in treatment
of trigger fingers and thumbs. J Hand Surg [Am] 1989; 14:722–727.
C&M criteria
(req
discussion)
Revised
Croydon list
Oxfordshire
PCT
Aesthetic/ cosmetic surgery
Aesthetic/
cosmetic
surgery
NHS Modernisation Agency. Action on plastic surgery. Referrals and
guidelines in plasticsurgery. Information for commissioners of plastic
surgery services. London: NHS Modernisation Agency; 2005.
NHS Modernisation Agency. Action on plastic surgery: a strategic
approach to the delivery of the NHS plastic, reconstructive and
aesthetic surgery service. London: NHS Modernisation Agency;
2005.
Department of Health. Cosmetic surgery and non-surgical cosmetic
treatments. Webpage.[Cited 19th Sept 2007] Available at:
http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopi
cs/CosmeticSurgery/index.htm
Fitzpatrick R, Klassen A, Jenkinson C, Goodacre T. Contrasting
evidence of the effectiveness of cosmetic surgery from two healthrelated quality of life measures. J Epidemiol Community Health
1999; 53: 440-41.
U.S. Food and Drug Administration. FDA approves Botox to treat
frown lines. FDA Talk Paper 2002. Available at:
11
Listed as one entry, but HRG codes provided
11
Action On Plastic Surgery ‘Information for
Commissioners of Plastic Surgery Services Referrals and Guidelines in Plastic
Surgery‘.(national guidelines)
http://www.glospct.nhs.uk/pdf/publications/innf/co
mmissionersplasticsurgery.pdf
SEL with
exceptions
INEL11
NCL
Comments
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
Comments
http://www.fda.gov/bbs/topics/ANSWERS/2002/ANS01147.html
[Accessed 19th Sept 2007]
Aesthetic/
cosmetic
genital surgery
B01
Aesthetic
surgery –
breast
B02
Breast
augmentation
(breast
enlargement)
B02a
Action On Plastic Surgery ‘Information for
Commissioners of Plastic Surgery Services –
Referrals and Guidelines in Plastic Surgery’
(national guidelines)
Cosmetic
Action On Plastic Surgery ‘Information for
Commissioners of Plastic Surgery Services –
Referrals and Guidelines in Plastic Surgery’
(national guidelines)
Cosmetic
Cosmetic
Newham provided the following evidence sources (to support
funding?)
Dixon, J, et al, 1994, ABC of breast diseases: congenital problems
and aberrations of normal breast development and involution, Br
Med J, 309, 24 September, 797-800.
Norfolk
NWL Policy
SEL with
exceptions
ETR (Newham
PCT)13
NWL with
exceptions
SEL with
exceptions
SWL criteria
C&M criteria
Heimberg, D, et al, 1996, The tuberous breast deformity:
classification and treatment, Br J Plast Surg, 49, 339-45.
Westminster
Brent PCT
Sadove, C, et al, 2005, Congenital and acquired pediatric breast
anomalies: a review of 20 years experience, Plast Reconstruct Surg,
April, 115(4), 1039-1050.
Vale of Glamorgan Local Health Board, 2006, Policy on the
‘Penile implant’ listed
The impact of breast hypoplasia on the growth of breasts. Examples of policies from other PCTs looking at whether augmentation surgery might be funded
12
(Blue)
Western
Cheshire
Freitas, R, et al, 2007, Poland’s Syndrome: different clinical
presentations and surgical reconstructions in 18 cases, Aesthet
Plast Surg, 31, 140-46.
North Derbyshire, South Derbyshire and Bassetlaw Commissioning
Consortium, 2007, Norcom commissioning policy – specialist plastic
surgery procedures”, 5-7.
13
C&M12
NWL Policy (D)
Pacifico, M, et al, 2007, The tuberous breast revisited, J Plast
Reconstruct Aesthet Surg, 60, 455-64.
12
NCL
(Blue)
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
Comments
NWL Policy (D)
NWL with
exceptions
(Blue)
commissioning of procedures of low priority or limited clinical
effectiveness not normally funded, Annex A, 3.36.
Mastopexy
(breast lift)
B02b
Cosmetic
SEL with
exceptions
SWL criteria
C&M criteria
Breast
prosthesis
removal or
replacement
B02c
Cosmetic
NWL Policy (D)
NWL with
exceptions
(Blue)
SEL with
exceptions
SWL criteria
C&M criteria
Cosmetic
breast surgery
B02d
Cosmetic
Inverted nipple
correction
B02e
Cosmetic
(Blue)
NWL Policy (D)
NWL with
exceptions
(Blue)
SEL no
exceptions
SWL
C&M criteria
Reduction
mammoplasty
(male or
female breast
reduction)
B02f
Cosmetic
NWL Policy (D) includes
Gynaecomastia
for
removal/mastecto
my of male
breast tissue
13
NWL with
exceptions
SEL with
exceptions
(female). Not
funded for
males
(Blue)
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
Comments
SWL criteria
C&M criteria
(reqs
discussion)
Revision
mammoplasty
B02g
Cosmetic
NWL Policy (D)
NWL with
exceptions
(Blue)
SEL with
exceptions
Aesthetic
surgery - ENT
B03
Cosmetic
Cosmetic
operations on
external ear
including
pinnaplasty
(bat ears),
otoplasty and
split earlobes
B03a
Cosmetic
Cosmetic
operations on
nose including
Rhinoplasty
B03b
Action On Plastic Surgery ‘Information for
Commissioners of Plastic Surgery Services –
Referrals and Guidelines in Plastic
Surgery’(national guidelines)
NWL Policy
Western
Cheshire
(Blue)
NWL Policy (D)
NWL with
exceptions
(Blue)
SEL with
exceptions
SWL criteria
C&M criteria
(reqs
discussion)
Cosmetic
NWL Policy (D)
NWL with
exceptions
(Blue)
SEL with
exceptions
SWL criteria
C&M criteria
Repair of
external ear
lobes
B03c
Cosmetic
NWL Policy (D)
NWL with
exceptions
SWL criteria
C&M criteria
14
(Blue)
Procedure
DFI
Code
Rationale
category
Meatoplasty of
external ear
B03d
Cosmetic
Aesthetic
surgery opthalmology
B04
Cosmetic
Blepharoplasty
B04a
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
Comments
(Blue)
Cosmetic
Action On Plastic Surgery ‘Information for
Commissioners of Plastic Surgery Services –
Referrals and Guidelines in Plastic Surgery’
(national guidelines)
NWL Policy
The British Association of Aesthetic Plastic
Surgeons www.baap.org.uk
NWL Policy (D)
SEL
Western
Cheshire
ONEL
Exclusions to the range of cosmetic surgery
(procedures undertaken within the ASG Health
Authorities). Cambridgeshire and Huntingdon
Health Authority. April 2007
NWL with
exceptions
(Blue)
SEL with
exceptions
ONEL with
exceptions
SWL criteria
C&M criteria
Waltham
Forest
West Essex
Correction of
ptosis
B04b
Cosmetic
Laser surgery
for myopia
(short sight)
n/a
?Cosmetic/
Costeffective
alternative
Aesthetic
surgery plastics
B05
Cosmetic
Abdominoplasty /
apronectomy
B05a
Cosmetic
Action On Plastic Surgery ‘Information for
Commissioners of Plastic Surgery Services –
Referrals and Guidelines in Plastic Surgery’
(national guidelines)
NWL Policy (A)
NWL
NWL Policy
Revised
Croydon list
NWL Policy (D)
NWL with
exceptions
SEL with
exceptions
15
(Blue)
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
Comments
SWL criteria
C&M criteria
(reqs
discussion)
Other skin
excision for
contour e.g.
buttock lift,
thigh lift, arm
lift
(brachioplasty)
B05b
Cosmetic
NWL Policy (D)
NWL No
exceptions
(Blue)
SEL with
exceptions
SWL criteria
C&M (reqs
discussion)
Correction of
male pattern
baldness/
correction of
hair loss
(Alopecia)
Hair grafting
Hair
transplantation
B05c
Cosmetic
Islingtion provided following evidence sources (to support funding?)
NWL Policy (D)
Otberg N, Wu WY, Kang H, Martinka M, Alzolibani AA, Restrepo I,
et al. Folliculitis decalvans developing 20 years after hair restoration
surgery in punch grafts: case report. Dermatol Surg
2009;35(11):1852-6
ETR (Islington
PCT)14
Otberg N, Kang H, Alzolibani AA, Shapiro J. Folliculitis decalvans.
Dermatol Ther 2008;21(4):238-44.
SEL no
exceptions
SWL criteria
C&M criteria/
exceptions
Harries MJ, Sinclair RD, Macdonald-Hull S, Whiting DA, Griffiths CE,
Paus R. Management of primary cicatricial alopecias: options for
treatment. Br.J Dermatol. 2008 Jul;159(1):1-22.
Unger W, Unger R, Wesley C. The surgical treatment of cicatricial
alopecia. Dermatol Ther. 2008 Jul-Aug;21(4):295-311.
Wu WY, Otberg N, McElwee KJ, Shapiro J. Diagnosis and
management of primary cicatricial alopecia: part II. SKINmed
2008;7(2):78-83.
Chandrawansa PH, Giam Y-C, Folliculitis decalvans – a
retrospective study in a tertiary referred centre over five years.
Singapore Med J. 2003 44(2):84-87
14
NWL No
exceptions
Hair transplant surgery for a patient with extensive alopecia and unsightly scarring
16
Listed
procedures
need
clarification
(Blue)
Procedure
DFI
Code
Rationale
category
Cosmetic
excision of
skin of head or
neck: e.g. face
lift or brow lift
(rhytidectomy)
B05d
Cosmetic
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
Comments
NWL Policy (D)
NWL with
exceptions
(Blue)
SEL with
exceptions
SWL
C&M criteria
Aesthetic
surgery liposuction
B06
Action On Plastic Surgery ‘Information for
Commissioners of Plastic Surgery Services –
Referrals and Guidelines in Plastic Surgery’
(national guidelines)
Cosmetic
NWL Policy (D)
NWL no
exceptions15
(Blue)
SWL criteria
C&M criteria
Minor skin
surgery for
non-cancerous
lesions16
B07
Action On Plastic Surgery ‘Information for
Commissioners of Plastic Surgery Services –
Referrals and Guidelines in Plastic Surgery’
(national guidelines)
Cosmetic
NWL with
exceptions
(Green)
C&M criteria
Revised
Croydon list
Orthodontic
treatments for
essentially
cosmetic
nature
B08
Resurfacing/ot
her minor skin
prodecures,
including
removal of
lipomata
B09
Cosmetic
Brook PH, Shaw WC. The development of an index of orthodontic
treatment priority. Eur J Orthod 1989; 11: 309-20.
Richmond S, Shaw WC, Stephens CD et al. Orthodontics in the
general dental service of England and Wales: Critical assessment of
standards. Br Dent J 1993; 174: 315.
Cosmetic
Action On Plastic Surgery ‘Information for
Commissioners of Plastic Surgery Services –
Referrals and Guidelines in Plastic Surgery’
(national guidelines)
NWL Policy (D)
Action On Plastic Surgery ‘Information for
Commissioners of Plastic Surgery Services –
Referrals and Guidelines in Plastic Surgery’
(national guidelines)
NWL Policy (D)
NWL with
exceptions
Original
Croydon list
ONEL
SWL
NWL with
exceptions
SEL
ONEL
SWL criteria
C&M (reqs
15
16
Liposuction is sometimes done as an adjunct to other surgical procedures. Liposuction simply to correct the distribution of fat may not be funded.
OPCS codes here are indicating an exclusion of all procedure codes used in intervention ―B09 Resurfacing/Other Minor Skin Procedures, for the purposes of avoiding duplication.
17
(Green)
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
Comments
discussion)
Western
Cheshire
Norfolk
Waltham
Forest
West Essex
Berkshire
Resurfacing/
other minor
skin
procedures
B09a
Cosmetic
Dermabrasion
of skin of head
or neck
B09b
Cosmetic
(Green)
SEL with
exceptions
(Green)
INEL
C&M criteria
Dermabrasion
of skin NEC
B09c
Cosmetic
Removal of
tattoo
B09d
Cosmetic
(Green)
Modernisation Agency’s Action on Plastic Surgery
2005
NWL Policy (D)
NWL with
exceptions
(Green)
SEL no
exceptions
SWL
C&M criteria
Refashioning
of scar NEC
B09e
Cosmetic
SEL with
exceptions
NCL
C&M
18
Patients may
be eligible for
treatment of
scars which
interfere with
function
following
burns or
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
Comments
treatments for
keloid or post
surgical
scarring
(Green)
Diagnostic
dermatoscopy
of skin
B09f
Cosmetic
Electrolysis of
hair
B09g
Cosmetic
Also:
(Green)
BMJ Clinical Evidence
(http://clinicalevidence.bmj.com/ceweb/conditions/woh/1408/1408,js
p) – The latest clinical evidence on hirsutism
Haedersdal M, Gotzsche PC. Laser and photoepilation for unwanted
hair growth. Cochrane Database Syst Rev 2006;(4):CD004684
Hair depilation
/ Hursuitism
Modernisation Agency’s Action on Plastic Surgery
2005
NWL Policy (D)
NWL with
exceptions
(Green)
SWL criteria
C&M criteria
Koulouri O, Conway G. S. Management of hirsutism. BMJ
2009;338:b847
Other
specified other
operations on
skin
B09h
Cosmetic
(Green)
Excision of
scar tissue
NOC
B09i
Cosmetic
(Green)
Other
specified laser
therapy to
organ NOC
B09j
Cosmetic
Unspecified
laser therapy
to organ NOC
B09k
Cosmetic
17
INEL17
(Green)
(Green)
Tunable dye laser
19
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Laser
treatment for
soft palate
(snoring)
n/a
Balance of
clinical
evidence
ONEL conclude there is a lack of long term clinical evidence on this
treatment. Despite this there is some evidence that treatment can
improve people’s physical, emotional and social wellbeing.
Removal of
benign skin
lesions
B09l
Cosmetic
Removal of
birthmarks
n/a
Varicose veins
B10
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
ONEL
ONEL case by
case
SEL with
exceptions/
notification
Comments
(Green)
SEL with
exceptions
Cosmetic
Action On Plastic Surgery ‘Information for
Commissioners of Plastic Surgery Services –
Referrals and Guidelines in Plastic Surgery’
(national guidelines)
Bradbury A, Evans C, Allan P et al. What are the symptoms of
varicose veins? Edinburgh vein study cross sectional population
survey. BMJ 1999;318:353-356 ( 6 February )
Campbell B. Varicose veins and their management. BMJ 2006;
333(7562): 287–292.
Cullum N, Nelson EA, Fletcher AW, Sheldon TA. Compression for
venous leg ulcers. Cochrane Database of Systematic Reviews 2001,
Issue 2. Available at:
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/C
D002303/pdf_fs.html [Accessed 2nd Oct 2007]
Houghton AD, Panayiotopoulos Y, Taylor PR. Practical
management of primary varicose veins. Br J Clin Pract.
1996;50:103-105.
Kurz X, Kahn SR, Abenhaim L, et al. Chronic venous disorders of
the leg: Epidemiology, outcomes, diagnosis and management:
summary of an evidence-based report of the VEINES task force. Int
Angiol 1999;18:83-102.
Simpson, S. & Roderick, P. in Stevens, A.,
Raftery, J., Mant, J. & Simpson, S. (eds) Health
Care Needs Assessment First Series, Volume 1,
Second Edition “Varicose Veins & Venous Ulcers”
(2004)
Department of Health. Healthcare Needs
Assessment. Accessible at http://hcna.radcliffeoxford.com/vvframe.htm
NICE “Referral Advice: a guide to appropriate
referral from general practice to specialist
services” London: National Institute for Clinical
Excellence, 2001
NICE Interventional Procedures guidance IPG8
(September 2003)
London NJM, Roddy Nash. Clinical review. ABC of arterial and
venous disease: Varicose Veins. BMJ May 2000; 320: 1392-94
NICE Interventional Procedures guidance IPG52
(March 2004)
Michaels JA, Campbell WB, Brazier JE et al. Randomised clinical
trial, observational study and assessment of cost-effectiveness of
the treatment of varicose veins (REACTIV trial). Health Technol
Assess 2006; 10(13).
Neglen P, Einarsson E, Eklof B. The functional long-term value of
different types of treatment for saphenous vein incompetence. J
Cardiovasc Surg 1993;34:295-301.
20
NWL Policy (D)
ONEL
SWL
NWL criteria
for severe
cases (noncosmetic)
SEL with
exceptions/
notification
ONEL
INEL
NCL
SWL criteria
C&M criteria
(req
discussion)
Balance of
evidence
(Green)
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
Comments
NICE CG13 Caesarean section.
NWL Policy (A)
NWL no
exceptions
Should this be
categorised as
Balance of
clinical
evidence (not
proven)?
Nelson EA, Bell-Syer SEM, Cullum NA. Compression for preventing
recurrence of venous ulcers. Cochrane Database of Systematic
Reviews 2000, Issue 4. Available at :
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/C
D002303/pdf_fs.html [Accessed 2nd Oct 2007]
Nelson EA, Cullum N, Jones J. Venous leg ulcers. BMJ Clinical
Evidence 2006. Available at:
http://clinicalevidence.bmj.com/ceweb/about/index.jsp [Accessed
19th Sept 2007]
Sowerby Centre for Health Informatics at Newcastle (SCHIN).
Thrombophlebitis. PRODIGY Guidance. Newcastle upon Tyne,
SCHIN. Updated July 2002. Available at:
http://www.cks.library.nhs.uk/help/about_us/what_is_schin
[Accessed 19th Sept 2007]
Tisi PV, Beverley CA. Injection sclerotherapy for varicose veins.
Cochrane Database of Systematic Reviews 2006, Issue 4. Available
at:
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/C
D001732/pdf_fs.html [Accessed 2nd Oct 2007]
Tisi P. Varicose veins. Surgery. BMJ Clinical Evidence 2006.
Available at: http://clinicalevidence.bmj.com/ceweb/about/index.jsp
[Accessed 19th Sept 2007]
Van Rij AM et al. Obesity and impaired venous function. Eur J Vasc
Endovasc Surg 2008 Feb 272006; 333(7562): 287–292.
Weiss R. Commentary on endovenous laser. Dermatol Surg
2001;27:326-327.
Weiss RA, Weiss MA. Controlled radiofrequency endovenous
occlusion using a unique radiofrequency catheter under duplex
guidance to eliminate saphenous varicose vein reflux: A 2-year
follow-up. Dermatol Surg 2002;28:38-42.
Caesarean
section for
non-clinical
reasons
C01
Clinical
criteria
Lavender T, Hofmeyr GJ, Neilson JP et al. Caesarean section for
non-medical reasons at term. Cochrane Database of Systematic
Reviews 2006, Issue 3. Available at:
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/C
D004741/pdf_fs.html [Accessed 2nd Oct 2007]
21
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
Comments
London at top
national
quartile
(Blue)
Cataract
surgery
C02
Clinical
criteria
Castells X, Comas M, Alonso J, Espallargues M, Martinez V, GarciaArumi J et al. In a randomized controlled trial, cataract surgery in
both eyes increased benefits compared to surgery in one eye only. J
Clin Epidemiol. 2006; 59(2):201-7.
Laidlaw DA, Harrad RA, Hopper CD, Whitaker A, Donovan JL,
Brookes ST et al. Randomised trial of effectiveness of second eye
cataract surgery. Lancet. 1998; 19:(9132):925-9.
Busbee BG, Brown MM, Brown GC, Sharma S. Cost-utility analysis
of cataract surgery in the second eye. Ophthalmology. 2003;
110(12):2310-2317.
NICE IPG209 Implantation of accommodating
intraocular lens for cataract. Feb 2007
ONEL
ONEL
SWL
SWL criteria
NICE IPG264 Implantation of multifocal (nonaccommodative) intraocular lenses for cataract
surgery: guidance
(Yellow)
Norfolk
Suffolk
Department of Health. Commissioning Toolkit for
Community Based Eyecare Services (DH 2007)
NHS Executive. Action on Cataracts: Good
practice guidance (Jan 2003)
NHS Bedfordshire and Hertfordshire Priorities
Forum (accessed March 2010)
Circumcision
C03
Clinical
criteria
“Statement on Male Circumcision”. Statement
from the British Association of Paediatric
Surgeons, The Royal College of Nursing, The
Royal College of Paediatrics and Child Health,
The Royal College of Surgeons of England and
The Royal College of Anaesthetists. 6 March
2001.
Lerman SE, Liao J: Neonatal circumcision. Paediatric Clinics of
North America 2001; 48: 1539-57
Rickwood AMK. Medical indications for circumcision. Br J Urol
International 1999; 83(Suppl): 45-51
Gatrad AR, Sheikh A, Jacks H. Religious circumcision and the
Human Rights Act. Arch Dis Child 2002; 86; 76-80
“The law and ethics of male circumcision guidance for doctors” BMA, June 2006
English Court of Appeal – Re J (Specific Issue Orders: Child's
Religious Upbringing and Circumcision) Journal of Law and Med
2000; 9: 68 -75
Siegfried N, Muller M, Volmink J, Deeks J, Egger M, Low N, et al.
Male circumcision for prevention of heterosexual acquisition of HIV
in men. Cochrane Database of Systematic Reviews 2003, Issue 3.
Available at:
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/C
D003362/pdf_fs.html [Accessed 2nd Oct 2007]
Baillis SA, Halperin DT. Male circumcision: time to re-examine the
evidence. Student BMJ 2006; 14: 179
Ehman AJ. Cut circumcision from list of routine services,
Saskatchewan MDs advised. CMAJ 2002; 167:532. Available at:
22
Berkshire NHS Priorities Website (accessed
March 2009)
NWL Policy (D)
ONEL
SWL
NWL with
exceptions
SEL with
exceptions
ONEL
INEL
SWL criteria
NCL
C&M (reqs
discussion)
West Essex
Western
Cheshire
(Blue)
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
Comments
NICE Technology Appraisal Guidance166.
Cochlear implants for children and adults with
severe to profound deafness. Issue date January
2009.
SWL
SEL with
exceptions/
notification
Costeffectiveness?
http://www.cmaj.ca/cgi/reprint/167/5/532-a [Accessed 19th Sept
2007]
Busbee B Cost-utility analysis of cataract surgery in the second eye.
Ophthalmology, Volume 110, Issue 12, Pages 2310-2317
Tobacman JK, Lee P, Zimmerman B, Kolder H, Hilborne L,
Assessment of appropriateness of cataract surgery at ten academic
medical centers in 1990. Ophthalmology. 1996 Feb;103(2):207-15.
Choi YJ, Hong YJ, Kang H. Appropriateness ratings in cataract
surgery. Yonsei Med J 2004;45:396-405
Mangione CM, Oray EJ, Lawrence MG et al. Prediction of visual
function after cataract surgery. A prospectively validated model.
Arch Opthal. 1995;113:1305-1311.
Brogan C, Lawrence D, Pickard D, Benjamin L. Can the use of
visual disability questionnaires in primary care help reduce
inequalities in cataract surgery rates?–a long term cohort study. In
press
Cochlear
implant
C04
Clinical
criteria
O’Donoghue GM, Nikolopoulos TP, Archbold SM, Tait M. Speech
perception in children after cochlear implantation. American Journal
of Otolaryngology. 1998 Nov; 19 (6): 762-67.
SWL criteria
Summerfield AQ, Marshall DH. Cochlear
Implantation in the UK 1990-1994. Report by the
MRC Institute of Hearing research on the
evaluation of the national cochlear implant
programme. London: HMSO, 1995.
NCL
C&M criteria/
exceptions
London at top
national
quartile
(Green)
West Sussex
Cochlear Implant and Bone Anchored Hearing
Aid Review Group. Provisional Report on the
need for Cochlear Implant Surgery in Avon.
RNID. Cochlear Implant Services Commissioning Guidelines. 2007.
Dental
implants
C05
Clinical
criteria
Meraw SJ et al. Analysis of surgical referral patterns for endosseous
dental implants. The International Journal of Oral and Maxillofacial
Implants 14(2), 265-270, 1999.
Balshi TJ et al. Analysis of 356 pterygomaxillary implants in
edentulous arches for fixed prosthesis anchorage. International
Journal of Oral and Maxilofacial Implants 14 (3), 398-406, 1999.
Royal College of Surgeons 1997 Guidelines for
Selecting Appropriate Patients To Receive
Treatment With Dental Implants: Priorities For
The NHS
http://www.rcseng.ac.uk/dental/fds/pdf/ncg97.pdf
The Consort Group, The Consort Statement:
revised recommendations for improving the
23
NWL Policy (D)
NWL with
exceptions
INEL
SWL
NCL
Need to
review content
of Consort
Group and
Scottish
Needs
Assessment
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
Awad M A, Locker D, Korner-Bitensky N, Feine J S. Measuring the
effect of intra-oral implant rehabilitation on health related quality of
life in a randomised controlled clinical trial. J Dent Res 2000; 79(9):
1659-63.
quality of reports of parallel group randomised
trials 2001 http://www.consort-statement.org/
Local review of
evidence (by
sector or PCT)
Referral
guidance
Comments
Report
London at top
national
quartile
Scottish Needs Assessment Report. Dental
Implants. 2004.
Jonsson B, Karlsson G. Cost-benefit evaluation of dental implants.
Int J Technol Assess Health Care 1990; 6(4): 545-57.
Goodacre CJ, Kan JY, Rungcharassaeng K. Clinical Complications
of Osseointegrated Implants. The Journal of Prosthetic Dentistry
1999; 81(5): 537-52.
Lindh T, Gunne J, Tillberg A, Molin M. A meta-analysis of implants in
partial edentulism. Clinical Oral Implants Research 1998; 9: 80-90.
Creugars N H, Kreulin C M, Snoek P A, de Kanter R J. A systematic
review of single-tooth restorations supported by implants. J Dent
Res 2000; 28(4): 209-17.
McCord JF, Michelinakis G. Systematic review of the evidence
supporting intra-oral maxillofacial prosthodontic care. European
Journal of Prosthodontics and Restorative Dentistry. 2004;12:12935.
Attard NJ, Zarb GA, Laporte A. Long-term treatment costs
associated with implant-supported mandibular prostheses in
edentulous patients. International Journal of Prosthodontics.
2005;18: 117-23.
Lekholm U. The Surgical Site. In Lindhe J, Karring K and Lang NP
(eds). Clinical Periodontology and Implant Dentistry. 3rd ed, p 890905. Copenhagen: Munksgaard, 1998.
Bory E, Durieux P. Oral implantology. Current state of knowledge.
Paris: Agence Nationale pour le Developement de l‘Evaluation
Medicale. L‘Agence Nationale d‘Accreditation d‘Evaluation en Sante
(ANAES). 1993; 87.
Dupuytren‘s
contracture
C06
Clinical
criteria
Bulstrode NW, Jemec B, Smith PJ. The complications of
Dupuytren's contracture surgery. J Hand Surg [Am] 2005
Sep;30(5):1021-5.
NICE Guidance CG34 (February 2004)
ONEL
SEL criteria/
notification
ONEL
Dias JJ and Braybrooke J. Dupuytren's contracture: an audit of the
outcomes of surgery. J Hand Surg [Br] 2006 Oct;31(5):514-21.
INEL
NCL
Bird B, Ball C, Balasuntharam P. Rehabilitation after surgery for
Dupuytren’s Contracture. (Protocol) Cochrane Database of
Systematic Reviews 2007, Issue 2.
Brighton
24
(Blue)
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Townley W A, Baker R, Sheppard N, Grobbelaar A O. Clinical
review: Dupuytren's contracture unfolded BMJ 2006;332:397400 (18 February)
Referral
guidance
Comments
Revised
Croydon list
Hindocha S, Stanley JK, Watson S, Bayat A. Dupuytrens’s diathesis
revisited: Evaluation of prognostic indicators for risk of disease
recurrence. J Hand Surg (Am) 2006 Dec;31(10):1626-34.
Surgical
treatment
female genital
prolapse/
stress
incontinence
C07
Clinical
criteria
Thakar R, Stanton S. Management of genital prolapse. BMJ 2002;
324:1258-1262.2.18
Jackson S, Smith P. Diagnosing and managing genitourinary
prolapse. BMJ 1997;314:875-80.
NICE CG40. Urinary incontinence - The
management of urinary incontinence in women –
October 2006
Original
Croydon list
(Blue)
Bump RC, Cundiff GW. Pelvic organ prolapse. In:
Stanton SL, Monga AK, eds.Clinical
urogynaecology. London: Churchill Livingstone,
2001.
Cardozo L. Prolapse. In: Whitfield CR, ed.
Dewhurst's textbook of obstetrics and
gynaecology for postgraduates. Oxford: Blackwell
Science, 1995.
Swift S, Theofrastous J. Aetiology and
classification of pelvic organ prolapse. In:Cardozo
L, Staskin D, eds. Textbook of urology and
urogynaecology. London, 2001.
Continence Foundation (www.continencefoundation.org.uk )
Hip
arthroplasty
C08
Hip
arthroplasty
C08a
Clinical
criteria
Clinical
criteria
Suffolk
Alberta Bone and Joint Institute. Evidence Review: Appropriateness
Criteria for THA and TKA. Version 1: May 17,2006.
Busato A; Roder C; Herren S; Eggli S Influence of high BMI on
functional outcome after total hip arthroplasty. Obesity Surgery, May
2008, vol./is. 18/5(595-600), 0960-8923
Dowsey MM; Choong PF. Obesity is a major risk factor for prosthetic
18
ONEL18
Scottish Arthroplasty project
‘Hip surgery’ is on draft list, but evidence review and recommendations have not yet been written
25
NICE. Guidance on the use of metal on metal hip
resurfacing arthroplasty. Technology Appraisal
Guidance No 44, 2002.
NICE. Consensus Development programme. Dec
2003
Department of Health,2006. The Musculoskeletal
SWL
SWL criteria
(Green)
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
infection after primary hip arthroplasty. Clinical Orthopaedics &
Related Research, January 2008, vol./is. 466/1(153-8)
Services Framework – A joint responsibility: doing
it differently.
Local review of
evidence (by
sector or PCT)
Referral
guidance
Comments
Field R et al. 11th European Forum on Quality in Health Care.Dixon
T, Shaw M, Ebrahim S, Dieppe P. Trends in hip and knee joint
replacement: socioeconomic inequalities and projections of need.
Ann rheum Dis 2004;63;825-830.
Field RE, Cronin MD, Singh PJ. The Oxford hip scores for primary
and revision hip replacement. Journal of Bone and Joint Surgery
[Br]2005;87-B:618-22
Murray DW, Fitzpatrick R, Rogers K, Pandit H et al. Journal of Bone
and Joint Surgery [Br] 2007; 89:8:pg 1010, 5pags
Patel AD; Albrizio M. Relationship of body mass index to early
complications in hip replacement surgery: study performed at
Hinchingbrooke Hospital, Orthopaedic Directorate, Huntingdon,
Cambridgeshire. International Orthopaedics, August 2007, vol./is.
31/4(439-43), 0341-2695
Hip
resurfacing
C08b
Clinical
criteria
Hybrid hip
replacement
C08c
Clinical
criteria
Hip revision
C09
Clinical
criteria
Hip revision
C09a
Clinical
criteria
Hybrid hip
revision
C09b
Clinical
criteria
Knee
C10
Clinical
19
Lubbeke A; Moons KG; Garavaglia G; Hoffmeyer P Outcomes of
obese and non-obese patients undergoing revision total hip
arthroplasty. Arthritis & Rheumatism, May 2008, vol./is. 59/5(73845), 0004-3591
On draft list as ‘knee procedure’, but evidence review and recommendations have not yet been written
26
Scottish Arthroplasty project
Suffolk
Scottish Arthroplasty project
ONEL19
(Yellow)
Procedure
DFI
Code
arthroplasty
Knee
arthroplasty
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
criteria
C10a
Clinical
criteria
Referral
guidance
Comments
Suffolk
Escobar A, Quintana JM, Arostehui I, Azkarate J, Güenaga,
Arenaza JC, Garai I. Development of explicit criteria for total knee
replacement. International Journal of Technology Assessment in
Healthcare, 2003; 19: 57-70
NHS Institute for Innovation and Improvement.
Delivering Quality and Value. Focus on:
Productivity and Efficiency. 2006
Field R et al. 11th European Forum on Quality in Health Care.
Hawker G, Wright J, Coyte P et al. Health related quality of life after
knee replacement . Results of the knee replacement patient
outcomes research team study. J Bone Joint Surg Am
1998;80A:163-803.
SWL
SWL criteria
(Yellow)
Department of Health, 2006. The Musculoskeletal
Services Framework – A joint responsibility: doing
it differently.
NICE. Consensus Development programme. Dec
2003
Hunter DJ, Felson DT. Osteoarthritis. BMJ 2006; 332:639-642
Jordan K M, Arden N K, Doherty M, Bannwarth B et al. EULAR
Recommendations 2003: an evidence based approach to the
management of knee osteoarthritis: Report of a Task Force of the
Standing Committee for International Clinical Studies Including
Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003;62;1145-1155
Quintana JM, Escobar A, Arostegui I, Bilbao A, Azkarate J,
Goenaga I and Arenaza J. Health related quality of life and
appropriateness of knee or hip joint replacement. Archives of
Internal Medicine, 2006; 166: 220-226.
Yasunaga H; Tsuchiya K; Matsuyama Y; Ohe K Analysis of factors
affecting operating time, postoperative complications, and length of
stay for total knee arthroplasty: nationwide web-based survey.
Journal of Orthopaedic Science, January 2009, vol./is. 14/1(10-6),
0949-2658
Yong PFK, Milner PC, Payne JN, Lewis PA, Jennison C. Inequalities
in access to knee joint replacements for people in need. Ann Rheum
Dis 2004;63:1483-1489
Hybrid knee
arthroplasty
C10b
Clinical
criteria
Knee revision
C11
Clinical
criteria
Knee revision
C11a
Clinical
criteria
(Yellow)
Scottish Arthroplasty project
Suffolk
(Yellow)
(Yellow)
27
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Hybrid knee
revision
C11b
Clinical
criteria
Surgery for
asymptomatic
gallstones
C12
Clinical
criteria
Fazili, FM. To operate or not to operate on asymptomatic gallstone
in laparoscopy, May 2010. On World Association of Laparoscopic
Surgeons website. http://www.wals.org.uk/article.htm (review article)
Wisdom teeth
extraction
C13
Clinical
criteria
Hugoson A Kugelberg C F. The prevalence of third molars in a
Swedish population epidemiological study: Community Dental
Health 1988:5; 121-138.
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
Comments
(Yellow)
Norfolk
NICE Technology Appraisal TA 1. Guidance on
the Removal of Wisdom Teeth, March 2000
Shepherd J P, Brickley M. Surgical removal of third molars. British
Medical Journal 1994:309; 620-621
http://www.bmj.com/cgi/content/full/309/6955/620
Song F, Landes D P, Glenny A M. Sheldon T A. Prophylactic
removal of impacted third molars: an assessment of published
reviews. British Dental Journal 1997:182(9):339 – 346.
Toth B. The appropriateness of prophylactic extraction of impacted
third molars: a review of the literature. Health Care Evaluation Unit,
University of Bristol 1993.
Daley T D. Third molar prophylactic extractions: a review and
analysis of the literature. General Dentistry 1996: 44(4); 310-320.
‘Management of Unerupted and Impacted Third
Molar Teeth’, SIGN Publication No. 43, March
2000
http://www.sign.ac.uk/guidelines/fulltext/43/index.
html
British Association of Oral Surgeons - ‘Removal
of wisdom teeth’ (accessed 1:10:08)
http://www.baos.org.uk/info.cfm
ONEL
ONEL20
SWL
INEL
(Green)
SWL criteria
NCL
C&M criteria
(req
discussion)
Royal College of Surgeons of England, Faculty of
Dental Surgery, clinical guidelines, ‘The
management of patients with third molar teeth’,
1997
Cost-effective alternative
Anal
procedures
D01
Costeffective
alternative
Ly-Pen D, Andreu JL, de Blas G, Sanchez-Olaso A, Millan I.
Surgical decompression versus local steroid injection in carpal
tunnel syndrome: a one-year, prospective, randomized, open,
controlled clinical trial. Arthritis Rheum 2005;52: 612-9
NICE Technology Appraisal TA 128. Stapled
haemorrhoidopexy for the treatment of
haemorrhoids, Sep 2007
J W H H Dammers, M M Veering, and M Vermeulen, Injection with
methylprednisolone proximal to the carpal tunnel: randomised
20
21
‘Knee procedures’ are on draft list, but evidence review and recommendations have not yet been written
On draft list, but evidence review and recommendations have not yet been written
28
ONEL21
C&M criteria
(req
discussion)
On original
Croydon list –
evidence
review not
done
Norfolk
(Green)
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
ONEL
ONEL
double blind trial BMJ 1999 319: 884-886.
A.C.F. Hui, S. Wong, C. H. Leung, P. Tong, V. Mok, D. Poon, C. W.
Li-Tsang, L. K. Wong, and R. Boet. A randomized controlled trial of
surgery vs. steroid injection for carpal tunnel syndrome. Neurology,
June 28, 2005; 64(12): 2074 - 2078.
Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for
carpal tunnel syndrome. The Cochrane Database of Systematic
Reviews 2002, Issue 4.
O'Connor D, Marshall S, Massy-Westropp N. Non-surgical treatment
(other than steroid injection) for carpal tunnel syndrome. The
Cochrane Database of Systematic Reviews 2003, Issue 1.
Verdugo RJ, Salinas RS, Castillo J, Cea JG. Surgical versus nonsurgical treatment for carpal tunnel syndrome. The Cochrane
Database of Systematic Reviews 2003, Issue 3
Sevim S, Dogu O, Camdeviren H, Kaleagasi H, Aral M, Arslan E,
Milcan A Long-term effectiveness of steroid injections and splinting
in mild and moderate carpal tunnel syndrome. Neurol Sci. 2004
Jun;25(2):48-52.
Gerritsen AA, de Vet HC, Scholten RJ, Bertelsmann FW, de Krom
MC, Bouter LM.Splinting vs. surgery in the treatment of carpal tunnel
syndrome: a randomized controlled trial. JAMA. 2002 Sep
11;288(10):1245-51.
Celiker R, Arslan S, Inanici F. Corticosteroid injection vs. nonsteroidal anti-inflammatory drug and splinting in carpal tunnel
syndrome. Am J Phys Med Rehabil. 2002 Mar;81(3):182-6.
Carpal tunnel
procedures
D02
Costeffective
alternative
Scholten RJPM, Mink van der Molen A, Uitdehaag BMJ, Bouter LM,
de Vet HCW. Surgical treatment options for carpal tunnel syndrome.
Cochrane Database of Systematic Reviews 2007, Issue 4.
Ly-Pen D, Andreu JL, de Blas G, Sanchez-Olaso A, Millan I.
Surgical decompression versus local steroid injection in carpal
tunnel syndrome: a one-year, prospective, randomized, open,
controlled clinical trial. Arthritis Rheum 2005;52: 612-9
SEL
notification
INEL
NCL
J W H H Dammers, M M Veering, and M Vermeulen, Injection with
methylprednisolone proximal to the carpal tunnel: randomised
double blind trial BMJ 1999 319: 884-886.
A.C.F. Hui, S. Wong, C. H. Leung, P. Tong, V. Mok, D. Poon, C. W.
Li-Tsang, L. K. Wong, and R. Boet. A randomized controlled trial of
29
C&M criteria
(req
discussion)
Revised
Croydon list
Comments
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
surgery vs. steroid injection for carpal tunnel syndrome. Neurology,
June 28, 2005; 64(12): 2074 - 2078.
Referral
guidance
Comments
Brent
Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for
carpal tunnel syndrome. The Cochrane Database of Systematic
Reviews 2002, Issue 4.
O'Connor D, Marshall S, Massy-Westropp N. Non-surgical treatment
(other than steroid injection) for carpal tunnel syndrome. The
Cochrane Database of Systematic Reviews 2003, Issue 1.
Verdugo RJ, Salinas RS, Castillo J, Cea JG. Surgical versus nonsurgical treatment for carpal tunnel syndrome. The Cochrane
Database of Systematic Reviews 2003, Issue 3
Sevim S, Dogu O, Camdeviren H, Kaleagasi H, Aral M, Arslan E,
Milcan A Long-term effectiveness of steroid injections and splinting
in mild and moderate carpal tunnel syndrome. Neurol Sci. 2004
Jun;25(2):48-52.
Gerritsen AA, de Vet HC, Scholten RJ, Bertelsmann FW, de Krom
MC, Bouter LM. Splinting vs. surgery in the treatment of carpal
tunnel syndrome: a randomized controlled trial. JAMA. 2002 Sep
11;288(10):1245-51.
Celiker R, Arslan S, Inanici F. Corticosteroid injection vs. nonsteroidal anti-inflammatory drug and splinting in carpal tunnel
syndrome. Am J Phys Med Rehabil. 2002 Mar;81(3):182-6.
Hyperhidrosis
treatment with
botulinum
toxin
D03
Costeffective
alternative
Naumann M, Lowe NJ. Botulinum toxin type A in treatment of
bilateral primary axillary hyperhidrosis: randomised, parallel group,
double blind, placebo controlled trial. BMJ 2001;323: 596 - ?
Haidar A, Solish N. Focal hyperhidrosis: diagnosis and
management. CMAJ 2005; 172: doi10.1503/cmaj.1040708.
Available at: http://www.cmaj.ca/cgi/content/full/172/1/69 [Accessed
19th Sept 2007]
Vangelova L. Botulinum toxin: a poison that can heal. US Food and
Drug Administration. Available at:
www.fda.gov/fdac/features/095_bot.html [Accessed 19th Sept 2007]
International Hyperhidrosis Society. Hyperhidrosis treatment.
Botulinum Toxin Injections (Botox®). Webpage. [Cited 19th Sept
2007] Available at:
www.sweathelp.org/English/HCP_Treatment_Botox.asp
International Hyperhidrosis Society. Hyperhidrosis treatment.
30
NWL Policy (D)
NWL with
exceptions
INEL
NCL
Costeffectiveness
compared to
other
treatment
options is yet
to be
established
London at top
national
quartile
Procedure
DFI
Code
Rationale
category
Published evidence and reviews eg original studies, systematic
reviews, meta-analyses, journal articles, text books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
Comments
NICE CG44 Heavy menstrual bleeding:
investigation and treatment – Jan 2007
ONEL
SEL with
exceptions/
notification
NWL does not
include
Botulinum Toxin Injections (Botox®): Safety. Webpage. [Cited 19th
Sept 2007]
http://www.sweathelp.org/English/HCP_Treatment_Botox_Safety.as
p
Hysterectomy
for noncancerous
heavy
menstrual
bleeding
D04
Costeffective
alternative
Marjoribanks J, Lethaby A, Farquhar C. Surgery versus medical
therapy for heavy menstrual bleeding. Cochrane Database of
Systematic Reviews 2006, Issue 2.
Nieboer TE, Johnson N, Barlow D, Lethaby A, Tavender E, Curr E,
Garry R, van Voorst S, Mol BWJ, Kluivers K. Surgical approach to
hysterectomy for benign gynaecological disease. Cochrane
Database of Systematic Reviews 2006, Issue 2.
SWL
Royal College of Obstetricians and
Gynaecologists (1999). Management of
Menorrhagia in Secondary Care
(Blue)
ONEL
INEL
SWL criteria
NCL
C&M criteria
(req
discussion)
NWL/Brent
West Essex
Berkshire
Hysteroscopy
Cancelled
procedures
D05
E01
Costeffective
alternative
Cancelled
procedures
NICE CG44 Heavy menstrual bleeding:
investigation and treatment – Jan 2007
Not applicable
Not applicable
31
Norfolk
Suffolk
Not applicable
(Green)