Polce: Consolidation of Evidence Base FINAL

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 Rationale Published evidence and reviews eg original studies, systematic Formal recommendations (NICE, professional Local review of Referral Comments Code category reviews, meta-analyses, journal articles, text books bodies, etc) evidence (by guidance sector or PCT)

Balance of clinical evidence

Apicectomy A01 Balance of British Association Oral and Maxillofacial NWL Policy (D) NWL with London at top clinical Surgeons. Referral guidelines. Apical surgery. exceptions national

evidence Previously available at 1 quartile http://www.baoms.org.uk/CD- NCL ROM/guidelines/Apical%20surgery.pdf (accessed 3rd October 2007) 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 A02 Balance of NICE Technology appraisal TA89 C&M criteria London at top chondrocyte clinical national implantation evidence Western quartile Cheshire (Blue)

1 Minor oral surgery for retained roots 4 Procedure DFI Rationale Published evidence and reviews eg original studies, systematic Formal recommendations (NICE, professional Local review of Referral Comments Code category reviews, meta-analyses, journal articles, text books bodies, etc) evidence (by guidance sector or PCT)

Injections and A03 Balance of Gibson JNA, Waddell G. Surgical interventions for lumbar disc NICE Clinical Guidance CG 88 (published May ONEL ONEL2 Also see fusion for back clinical prolapse. Cochrane Database of Systematic Reviews 2007, Issue 2. 2009) 3 listing for pain evidence SWL SWL critieria Lumbar disc Ibrahim T; Tleyjeh IM; Gabbar O. Surgical versus non-surgical 4 prolapse (A09) treatment of chronic low back pain: a meta-analysis of randomised Brighton trials. International Orthopaedics, February 2008, vol./is. 32/1(107- Suffolk (Blue) 13), 0341-2695 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), 1528- 1159 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 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: 1048- 55 Weber H. Lumbar disc herniation. A controlled, prospective study

2 Spinal surgery for non-acute lumbar conditions 3 Discectomy for lumbar disc prolapse 4 Vertebroplasty 5 Procedure DFI Rationale Published evidence and reviews eg original studies, systematic Formal recommendations (NICE, professional Local review of Referral Comments Code category reviews, meta-analyses, journal articles, text books bodies, etc) evidence (by guidance sector or PCT)

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 A04 Balance of Tower Hamlets provided the following sources (to support funding?) NICE, “Press release – guidance on hearing ETR (Tower Hampshire & anchored clinical aids”, 2000 Hamlets)5 Isle of Wight hearing aid evidence Dutt, S, et al, Patient satisfaction with bilateral bone-anchored PCTs (BAHA) hearing aids: the Birmingham experience, J Laryngol Otol, 2002, 116, 37-45, p 41. South Gloucester- Snik, A, et al, Candidacy for the bone-anchored hearing aid, Audiol shire PCT6 Neurotol, 2004, 9, 190-96, p196. Croydon list Snik, A, et al, Consensus statements on the BAHA system: where do we stand at present?, Ann Otol, Rhinol Laryngol, 2005, Dec, 114, Bedfordshire 12, 2-12, p7. and Hertfordshire7 REFER, Department of Health Research Findings Register, The use of bone-anchored hearing aids, REFER Summary, 2001, 1-3, p2. Doncaster http://www.refer.nhs.uk/ViewRecord.asp?id=505 Primary Care Trust8 Proops, D, The evidence base for aural rehabilitation with the bone- anchored 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 A05 Balance of Coulter A, Kelland J, Long A. The management of menorrhagia. NICE Clinical Guideline on heavy menstrual ONEL ONEL SWL does not curettage clinical Effective Health Care Bulletin 1995; (9). bleeding CG44 include evidence NWL Policy (D) NWL with Emanuel MH, Wamsteker K, Lammes FB. Is dilatation and curettage Royal College of Obstetricians and exceptions London at top obsolete for diagnosing intrauterine disorders in premenopausal Gynaecologists. Management of Menorrhagia in national patients with persistent abnormal uterine bleeding? Acta Obstet Secondary Care. 1999 SEL criteria/ quartile Gynecol Scand 1997; 76: 65. notification NHS Institute for Innovation and Improvement. (Blue) BMJ Clinical Evidence: Menorrhagia. Sept 06. NHS Better Care, Better Value Indicators: INEL Surgical thresholds indicators. 10 October 2007 NCL At http://www.productivity.nhs.uk/Definitions.aspx Accessed 26.3.08 C&M (req discussion)

5 The effectiveness of bone anchored hearing aids (BAHAs) for a patient who has profound mixed bilateral hearing loss 6 Minutes of meeting of exceptional funding panel 19th December 2005, EP263 Funding for Bone-Anchored Hearing Aid, p4 7 INTERIM Priorities Forum, Bone anchored hearing aids (BAHAs), Forum Statement 30, 2006, p 1. 8 Effective and appropriate healthcare, 2006, Bone anchored hearing aids, 6.1. http://www.doncasterpct.nhs.uk/yourhealth.asp?ArticleID=100029 6 Procedure DFI Rationale Published evidence and reviews eg original studies, systematic Formal recommendations (NICE, professional Local review of Referral Comments Code category reviews, meta-analyses, journal articles, text books bodies, etc) evidence (by guidance sector or PCT)

Brighton Croydon list Berkshire West Essex

Ganglia A06 Balance of Vroon P, Scholten RJ, van Weert HCPM. Interventions for ganglion NWL Policy (A) NWL with SWL does not clinical cysts in adults (Protocol). Cochrane Database of Systematic exceptions include evidence Reviews 2005, Issue 2. Available at: ONEL http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/C SEL (Blue) D005327/pdf_fs.html [Accessed 2nd Oct 2007] notification Burke FD, Melikyan EY, Bradley MJ, Dias JJ. Primary care referral ONEL protocol for wrist ganglia. Postgrad Med J 2003 79:329-331 INEL Bandolier. Wrist ganglia. Webpage. [Cited 19th Sept 2007]. NCL Available at: http://www.jr2.ox.ac.uk/bandolier/booth/miscellaneous/wristgang.htm Revised l 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 patient- reported treatment outcomes. J Hand Surg (Br) 2003;2: 172-6.

Grommets A07 Balance of Langton Hewer CD, McDonald S, Nunez DA. Grommets (ventilation NICE Clinical Guideline on surgical management NWL Policy (A) NWL Also see clinical tubes) for recurrent acute otitis media in children. Cochrane of otitis media with effusion CG60 adenoidect- evidence Database of Systematic Reviews 2004, Issue 2. Available at: ONEL SEL with omy SIGN Guideline 66 (2003) Diagnosis and exceptions http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/C SWL D004741/pdf_fs.html [Accessed 2nd Oct 2007] management of childhood Otitis Media in Primary (Blue) Care ONEL Lous J, Burton MJ, Felding JU, Ovesen T, Rovers MM, Williamson I. INEL Grommets (ventilation tubes) for hearing loss associated with otitis NHS Institute for Innovation and Improvement. media with effusion in children. Cochrane Database of Systematic NHS Better Care, Better Value Indicators: SWL criteria Reviews 2005, Issue 1. Available at: Surgical thresholds indicators. 10 October 2007 http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/C At http://www.productivity.nhs.uk/Definitions.aspx NCL Accessed 26.3.08 D001801/pdf_fs.html [Accessed 2nd Oct 2007] C&M criteria Maw, R., Wilks, J., Harvey, I. et al (1999) Early surgery compared Centre for Reviews and Dissemination. The (req with watchful waiting for glue ear and effect on language treatment of persistent glue ear in children. 1992. discussion) http://www.york.ac.uk/inst/crd/projects/glueear.ht development in preschool children: a randomised trial [published West Essex erratum appears in Lancet 1999 Oct 16;354(9187):1392]. Lancet m 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;s95- s118 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]

Grommets Yung MW, Arasaratnam R. Adult-onset otitis media with effusion: NHS Institute for Innovation and Improvement. Brighton (adults) results following ventilation tube insertion. J Laryngol Otol. 2001 NHS Better Care, Better Value Indicators: Nov;115(11):874-8 Surgical thresholds indicators. 10 October 2007 At http://www.productivity.nhs.uk/Definitions.aspx Montandon P, Guillemin P, Häusler R. Prevention of vertigo in Accessed 26.3.08 Ménière's syndrome by means of transtympanic ventilation tubes. ORL J Otorhinolaryngol Relat Spec. 1988;50(6):377-81.

Adenoidect- Lous J, Burton MJ, Felding J, Ovesen T, Rovers M, Williamson I. NICE Guidance CG60 (February 2008) ONEL SEL criteria/ May be omy for otitis Grommets (ventilation tubes) for hearing loss associated with otitis notification included in media in media with effusion in children. Cochrane Database of Systematic Grommets children Reviews 2005, Issue 1.Art.No.:CD001801.DOI:10.1002/ ONEL guidance 14651858.CD001801.pub2. INEL (Blue) Rosenfeld et al (2004) Clinical Practice Guideline: Otitis Media with NCL Effusion. Otolaryngology – Head and Neck Surgery (130);5;s95- s118 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 NICE IPG230 Arthroscopic knee washout, with or Clinical criteria clinical without debridement, for the treatment of – NICE restrict

evidence osteoarthritis. Aug 2007 to pts with mechanical NICE CG59 The care and management of locking. NICE osteoarthritis in adults. Feb 2008 have only commented on use in OA, not other conditions eg RA (Green)

Lumbar disc A09 Balance of Surgical Disorders of the Thoracic and Lumbar Spine: A Guide For ONEL ONEL9 Also see prolapse clinical Neurologists- Nitin Patel - J Neurol Neurosurg Psychiatry listing for evidence 2002;73:i42-i48 doi:10.1136/jnnp.73.suppl_1.i42 Revised Injections and Croydon list fusion for back Cochrane review of surgery for lumbar disc prolapse and pain (A03) degenerative lumbar spondylosis. Spine (Phila Pa 1976). 1999 Sep 1;24(17):1820-32. http://www.ncbi.nlm.nih.gov/pubmed/10488513

Spinal cord A10 Balance of McElveen WA. Postherpectic neuralgia. Emedicine review – last NICE - Pain (chronic neuropathic or ischaemic) - ETR (Camden West Sussex NICE stimulation10 clinical updated in Sept. 2008. Available online at: spinal cord stimulation. Issue date October 2008. PCT) recommends evidence http://www.emedicine.com/neuro/topic317.htm#section~Treatment http://guidance.nice.org.uk/TA159 Original SCC as Croydon list treatment Kumar, K et al. Spinal cord stimulation versus conventional medical NICE Technology Appraisal TA159 - Spinal cord option with management for neuropathic pain: a multicentre randomised stimulation for chronic pain of neuropathic or clinical criteria controlled trial in patients with failed back surgery syndrome. Pain. ischaemic origin. Issue date October 2008. 2007; 132: 179-88. http://www.nice.org.uk/nicemedia/live/12082/4236 ONEL advise 7/42367.pdf to consider Kumar K, Taylor RS, Jacques L, et al. The effects of spinal cord costs of stimulation in neuropathic pain are sustained: a 24-month follow-up different of the prospective randomized controlled multicenter trial of the systems effectiveness of spinal cord stimulation. Neurosurgery. 2008;63(4):762-70. London at top national Kemler MA, de Vet HC, Barendse GA, van den Wildenberg FA, van quartile Kleef M. Effect of spinal cord stimulation for chronic complex regional pain syndrome Type I: five-year final follow-up of patients in (Blue) 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).

9 Spinal surgery for non-acute lumbar conditions 10 ONEL categorises this under ‘Functional Electrical Stimulation’ 9 Procedure DFI Rationale Published evidence and reviews eg original studies, systematic Formal recommendations (NICE, professional Local review of Referral Comments Code category reviews, meta-analyses, journal articles, text books bodies, etc) evidence (by guidance sector or PCT)

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 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 McKerrow W. Tonsillitis. Tonsillectomy versus antibiotics in children. Royal College of Paediatrics and Child Health. NWL Policy (D) NWL with (Green) clinical BMJ Clinical Evidence 2006. Available at: Guidelines for good practice. Management of exceptions evidence http://clinicalevidence.bmj.com/ceweb/about/index.jsp [Accessed acute and recurring sore throat and indications for ONEL 19th Sept 2007] tonsillectomy. London: RCPCH; 2000 SEL with SWL exceptions Adenotonsillectomy for upper respiratory infections: evidence Scottish Intercollegiate Guidance Network. based? Arch Dis Child 2005;90:19–25 Management of sore throat and indications for ONEL tonsillectomy. Edinburgh: SIGN guidance 34 INEL Burton MJ, Glasziou PP. Tonsillectomy or adeno-tonsillectomy (1999, reviewed 2005). Available at: versus non-surgical treatment for chronic/recurrent acute tonsillitis. http://www.sign.ac.uk/guidelines/fulltext/34/index. SWL criteria Cochrane Database of Systematic Reviews 2009, Issue 1 html [Accessed 19th Sept 2007] NCL Van Staaij et al. Adeno-tonsillectomy for upper respiratory infections: evidence based? Arch Dis Child 2005; 90:19–25. C&M criteria (req Paradise JL, Bluestone CD, Bachman RZ, et al. Efficacy of discussion) tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical Western trials. N Engl J Med 1984; 310: 674-83. Cheshire 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. Thorax 2005; 60:595-604.

Trigger finger A12 Balance of Peters-Veluthamaningal C, van der Windt DAWM, Winters JC, ONEL SEL criteria/ (stenosing clinical Meyboom- de Jong B. Corticosteroid injection for trigger finger in notification tenosynovitis) evidence 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 INEL Am Acad Ortop Surg. 2007 Mar;15(3):166-71 NCL Marks MR, Gunther SF: Efficacy of cortisone injection in treatment C&M criteria of trigger fingers and thumbs. J Hand Surg [Am] 1989; 14:722–727. (req discussion) Revised Croydon list Oxfordshire PCT

Aesthetic/ cosmetic surgery

Aesthetic/ NHS Modernisation Agency. Action on plastic surgery. Referrals Action On Plastic Surgery ‘Information for SEL with cosmetic and guidelines in plasticsurgery. Information for commissioners of Commissioners of Plastic Surgery Services - exceptions surgery plastic surgery services. London: NHS Modernisation Agency; 2005. Referrals and Guidelines in Plastic Surgery‘. 11 (national guidelines) INEL NHS Modernisation Agency. Action on plastic surgery: a strategic http://www.glospct.nhs.uk/pdf/publications/innf/co NCL approach to the delivery of the NHS plastic, reconstructive and mmissionersplasticsurgery.pdf 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/inde x.htm Fitzpatrick R, Klassen A, Jenkinson C, Goodacre T. Contrasting evidence of the effectiveness of cosmetic surgery from two health- related 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: http://www.fda.gov/bbs/topics/ANSWERS/2002/ANS01147.html

11 Listed as one entry, but HRG codes provided 11 Procedure DFI Rationale Published evidence and reviews eg original studies, systematic Formal recommendations (NICE, professional Local review of Referral Comments Code category reviews, meta-analyses, journal articles, text books bodies, etc) evidence (by guidance sector or PCT)

[Accessed 19th Sept 2007]

Aesthetic/ B01 Cosmetic Action On Plastic Surgery ‘Information for NCL cosmetic Commissioners of Plastic Surgery Services – 12 genital surgery Referrals and Guidelines in Plastic Surgery’ C&M (national guidelines) Norfolk

Aesthetic B02 Cosmetic Action On Plastic Surgery ‘Information for NWL Policy SEL with (Blue) surgery – Commissioners of Plastic Surgery Services – exceptions breast Referrals and Guidelines in Plastic Surgery’ (national guidelines) Western Cheshire

Breast B02a Cosmetic Newham provided the following evidence sources (to support NWL Policy (D) NWL with (Blue) augmentation funding?) exceptions ETR (Newham (breast 13 enlargement) Dixon, J, et al, 1994, ABC of breast diseases: congenital problems PCT) SEL with and aberrations of normal breast development and involution, Br exceptions Med J, 309, 24 September, 797-800. SWL criteria Freitas, R, et al, 2007, Poland’s Syndrome: different clinical presentations and surgical reconstructions in 18 cases, Aesthet C&M criteria Plast Surg, 31, 140-46. Brent PCT Heimberg, D, et al, 1996, The tuberous breast deformity: Westminster classification and treatment, Br J Plast Surg, 49, 339-45. Pacifico, M, et al, 2007, The tuberous breast revisited, J Plast Reconstruct Aesthet Surg, 60, 455-64. North Derbyshire, South Derbyshire and Bassetlaw Commissioning Consortium, 2007, Norcom commissioning policy – specialist plastic surgery procedures”, 5-7. 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 commissioning of procedures of low priority or limited clinical effectiveness not normally funded, Annex A, 3.36.

Mastopexy B02b Cosmetic NWL Policy (D) NWL with (Blue) (breast lift)

12 ‘Penile implant’ listed 13 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 Procedure DFI Rationale Published evidence and reviews eg original studies, systematic Formal recommendations (NICE, professional Local review of Referral Comments Code category reviews, meta-analyses, journal articles, text books bodies, etc) evidence (by guidance sector or PCT)

exceptions SEL with exceptions SWL criteria C&M criteria

Breast B02c Cosmetic NWL Policy (D) NWL with (Blue) prosthesis exceptions removal or replacement SEL with exceptions SWL criteria C&M criteria

Cosmetic B02d Cosmetic (Blue) breast surgery

Inverted nipple B02e Cosmetic NWL Policy (D) NWL with (Blue) correction exceptions SEL no exceptions SWL C&M criteria

Reduction B02f Cosmetic NWL Policy (D) - NWL with (Blue) mammoplasty includes exceptions (male or Gynaecomastia female breast for SEL with reduction) removal/mastecto exceptions my of male (female). Not breast tissue funded for males SWL criteria C&M criteria (reqs discussion)

Revision B02g Cosmetic NWL Policy (D) NWL with (Blue) mammoplasty exceptions SEL with exceptions

Aesthetic B03 Cosmetic Action On Plastic Surgery ‘Information for NWL Policy Western (Blue) surgery - ENT Commissioners of Plastic Surgery Services – Cheshire Referrals and Guidelines in Plastic Surgery’(national guidelines)

Cosmetic B03a Cosmetic NWL Policy (D) NWL with (Blue) operations on exceptions external ear including SEL with pinnaplasty exceptions (bat ears), SWL criteria otoplasty and split earlobes C&M criteria (reqs discussion)

Cosmetic B03b Cosmetic NWL Policy (D) NWL with (Blue) operations on exceptions nose including Rhinoplasty SEL with exceptions SWL criteria C&M criteria

Repair of B03c Cosmetic NWL Policy (D) NWL with (Blue) external ear exceptions lobes SWL criteria C&M criteria

Meatoplasty of B03d Cosmetic (Blue) external ear

Aesthetic B04 Cosmetic Action On Plastic Surgery ‘Information for NWL Policy SEL surgery - Commissioners of Plastic Surgery Services – opthalmology Referrals and Guidelines in Plastic Surgery’ Western (national guidelines) Cheshire

Blepharoplasty B04a Cosmetic The British Association of Aesthetic Plastic NWL Policy (D) NWL with (Blue) Surgeons www.baap.org.uk exceptions ONEL Exclusions to the range of cosmetic surgery SEL with (procedures undertaken within the ASG Health exceptions Authorities). Cambridgeshire and Huntingdon Health Authority. April 2007 ONEL with exceptions SWL criteria C&M criteria Waltham Forest West Essex

Correction of B04b Cosmetic ptosis

Laser surgery n/a ?Cosmetic/ NWL Policy (A) NWL for myopia Cost- (short sight) effective alternative

Aesthetic B05 Cosmetic Action On Plastic Surgery ‘Information for NWL Policy Revised surgery - Commissioners of Plastic Surgery Services – Croydon list plastics Referrals and Guidelines in Plastic Surgery’ (national guidelines)

Abdomino- B05a Cosmetic NWL Policy (D) NWL with (Blue) plasty / exceptions apronectomy SEL with exceptions SWL criteria C&M criteria (reqs discussion)

Other skin B05b Cosmetic NWL Policy (D) NWL No (Blue) excision for exceptions contour e.g. buttock lift, SEL with thigh lift, arm exceptions 15 Procedure DFI Rationale Published evidence and reviews eg original studies, systematic Formal recommendations (NICE, professional Local review of Referral Comments Code category reviews, meta-analyses, journal articles, text books bodies, etc) evidence (by guidance sector or PCT) lift SWL criteria (brachioplasty) C&M (reqs discussion)

Correction of B05c Cosmetic Islingtion provided following evidence sources (to support funding?) NWL Policy (D) NWL No Listed male pattern exceptions procedures Otberg N, Wu WY, Kang H, Martinka M, Alzolibani AA, Restrepo I, ETR (Islington baldness/ 14 need correction of et al. Folliculitis decalvans developing 20 years after hair restoration PCT) SEL no clarification hair loss surgery in punch grafts: case report. Dermatol Surg exceptions 2009;35(11):1852-6 (Blue) (Alopecia) SWL criteria Hair grafting Otberg N, Kang H, Alzolibani AA, Shapiro J. Folliculitis decalvans. Dermatol Ther 2008;21(4):238-44. C&M criteria/ Hair exceptions transplantation 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

Cosmetic B05d Cosmetic NWL Policy (D) NWL with (Blue) excision of exceptions skin of head or neck: e.g. face SEL with lift or brow lift exceptions (rhytidectomy) SWL C&M criteria

Aesthetic B06 Cosmetic Action On Plastic Surgery ‘Information for NWL Policy (D) NWL no (Blue) surgery - Commissioners of Plastic Surgery Services – exceptions15 liposuction Referrals and Guidelines in Plastic Surgery’ (national guidelines) SWL criteria

14 Hair transplant surgery for a patient with extensive alopecia and unsightly scarring 15 Liposuction is sometimes done as an adjunct to other surgical procedures. Liposuction simply to correct the distribution of fat may not be funded. 16 Procedure DFI Rationale Published evidence and reviews eg original studies, systematic Formal recommendations (NICE, professional Local review of Referral Comments Code category reviews, meta-analyses, journal articles, text books bodies, etc) evidence (by guidance sector or PCT)

C&M criteria

Minor skin B07 Cosmetic Action On Plastic Surgery ‘Information for NWL with (Green) surgery for Commissioners of Plastic Surgery Services – exceptions non-cancerous Referrals and Guidelines in Plastic Surgery’ lesions16 (national guidelines) C&M criteria Revised Croydon list

Orthodontic B08 Cosmetic Brook PH, Shaw WC. The development of an index of orthodontic Action On Plastic Surgery ‘Information for NWL Policy (D) NWL with treatments for treatment priority. Eur J Orthod 1989; 11: 309-20. Commissioners of Plastic Surgery Services – exceptions essentially Referrals and Guidelines in Plastic Surgery’ cosmetic Richmond S, Shaw WC, Stephens CD et al. Orthodontics in the (national guidelines) Original nature general dental service of England and Wales: Critical assessment of Croydon list standards. Br Dent J 1993; 174: 315.

Resurfacing/ot B09 Cosmetic Action On Plastic Surgery ‘Information for NWL Policy (D) NWL with (Green) her minor skin Commissioners of Plastic Surgery Services – exceptions prodecures, Referrals and Guidelines in Plastic Surgery’ ONEL SEL including (national guidelines) SWL removal of ONEL lipomata SWL criteria C&M (reqs discussion) Western Cheshire Norfolk Waltham Forest West Essex Berkshire

Resurfacing/ B09a Cosmetic (Green) other minor skin procedures

16 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 Procedure DFI Rationale Published evidence and reviews eg original studies, systematic Formal recommendations (NICE, professional Local review of Referral Comments Code category reviews, meta-analyses, journal articles, text books bodies, etc) evidence (by guidance sector or PCT)

Dermabrasion B09b Cosmetic SEL with (Green) of skin of head exceptions or neck INEL C&M criteria

Dermabrasion B09c Cosmetic (Green) of skin NEC Modernisation Agency’s Action on Plastic Surgery Removal of B09d Cosmetic 2005 NWL Policy (D) NWL with (Green) tattoo exceptions SEL no exceptions SWL C&M criteria

Refashioning B09e Cosmetic SEL with Patients may of scar NEC exceptions be eligible for treatment of NCL scars which C&M interfere with function following burns or treatments for keloid or post surgical scarring (Green)

Diagnostic B09f Cosmetic (Green) dermatoscopy of skin

Electrolysis of B09g Cosmetic BMJ Clinical Evidence Modernisation Agency’s Action on Plastic Surgery NWL Policy (D) NWL with (Green) hair (http://clinicalevidence.bmj.com/ceweb/conditions/woh/1408/1408,js 2005 exceptions p) – The latest clinical evidence on hirsutism Also: SWL criteria Haedersdal M, Gotzsche PC. Laser and photoepilation for unwanted Hair hair growth. Cochrane Database Syst Rev 2006;(4):CD004684 C&M criteria depilation / Hursuitism Koulouri O, Conway G. S. Management of hirsutism. BMJ

2009;338:b847

Other B09h Cosmetic (Green) specified other operations on skin

Excision of B09i Cosmetic (Green) scar tissue NOC

Other B09j Cosmetic INEL17 (Green) specified laser therapy to organ NOC

Unspecified B09k Cosmetic (Green) laser therapy to organ NOC

Laser n/a Balance of ONEL conclude there is a lack of long term clinical evidence on this ONEL ONEL case by treatment for clinical treatment. Despite this there is some evidence that treatment can case soft palate evidence improve people’s physical, emotional and social wellbeing. (snoring)

Removal of B09l Cosmetic SEL with (Green) benign skin exceptions/ lesions notification

Removal of n/a SEL with birthmarks exceptions

Varicose veins B10 Cosmetic Bradbury A, Evans C, Allan P et al. What are the symptoms of Action On Plastic Surgery ‘Information for NWL Policy (D) NWL criteria Balance of varicose veins? Edinburgh vein study cross sectional population Commissioners of Plastic Surgery Services – for severe evidence survey. BMJ 1999;318:353-356 ( 6 February ) Referrals and Guidelines in Plastic Surgery’ ONEL cases (non- (national guidelines) cosmetic) (Green) Campbell B. Varicose veins and their management. BMJ 2006; SWL 333(7562): 287–292. Simpson, S. & Roderick, P. in Stevens, A., SEL with Raftery, J., Mant, J. & Simpson, S. (eds) Health exceptions/ Cullum N, Nelson EA, Fletcher AW, Sheldon TA. Compression for Care Needs Assessment First Series, Volume 1, notification venous leg ulcers. Cochrane Database of Systematic Reviews 2001, Second Edition “Varicose Veins & Venous Ulcers” Issue 2. Available at: ONEL http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/C

17 Tunable dye laser 19 Procedure DFI Rationale Published evidence and reviews eg original studies, systematic Formal recommendations (NICE, professional Local review of Referral Comments Code category reviews, meta-analyses, journal articles, text books bodies, etc) evidence (by guidance sector or PCT) (2004) D002303/pdf_fs.html [Accessed 2nd Oct 2007] INEL Houghton AD, Panayiotopoulos Y, Taylor PR. Practical Department of Health. Healthcare Needs NCL management of primary varicose veins. Br J Clin Pract. Assessment. Accessible at http://hcna.radcliffe- 1996;50:103-105. oxford.com/vvframe.htm SWL criteria C&M criteria Kurz X, Kahn SR, Abenhaim L, et al. Chronic venous disorders of NICE “Referral Advice: a guide to appropriate the leg: Epidemiology, outcomes, diagnosis and management: (req referral from general practice to specialist discussion) summary of an evidence-based report of the VEINES task force. Int services” London: National Institute for Clinical Angiol 1999;18:83-102. Excellence, 2001 London NJM, Roddy Nash. Clinical review. ABC of arterial and NICE Interventional Procedures guidance IPG8 venous disease: Varicose Veins. BMJ May 2000; 320: 1392-94 (September 2003) Michaels JA, Campbell WB, Brazier JE et al. Randomised clinical trial, observational study and assessment of cost-effectiveness of NICE Interventional Procedures guidance IPG52 the treatment of varicose veins (REACTIV trial). Health Technol (March 2004) 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. 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 C01 Clinical Lavender T, Hofmeyr GJ, Neilson JP et al. Caesarean section for NICE CG13 Caesarean section. NWL Policy (A) NWL no Should this be section for criteria non-medical reasons at term. Cochrane Database of Systematic exceptions categorised as non-clinical Reviews 2006, Issue 3. Available at: Balance of reasons http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/C clinical D004741/pdf_fs.html [Accessed 2nd Oct 2007] evidence (not proven)? London at top national quartile (Blue)

Cataract C02 Clinical Castells X, Comas M, Alonso J, Espallargues M, Martinez V, Garcia- NICE IPG209 Implantation of accommodating ONEL ONEL (Yellow) surgery criteria Arumi J et al. In a randomized controlled trial, cataract surgery in intraocular lens for cataract. Feb 2007 both eyes increased benefits compared to surgery in one eye only. J SWL SWL criteria Clin Epidemiol. 2006; 59(2):201-7. NICE IPG264 Implantation of multifocal (non- accommodative) intraocular lenses for cataract Norfolk Laidlaw DA, Harrad RA, Hopper CD, Whitaker A, Donovan JL, surgery: guidance Suffolk Brookes ST et al. Randomised trial of effectiveness of second eye cataract surgery. Lancet. 1998; 19:(9132):925-9. Department of Health. Commissioning Toolkit for Community Based Eyecare Services (DH 2007) Busbee BG, Brown MM, Brown GC, Sharma S. Cost-utility analysis of cataract surgery in the second eye. Ophthalmology. 2003; NHS Executive. Action on Cataracts: Good 110(12):2310-2317. practice guidance (Jan 2003) NHS Bedfordshire and Hertfordshire Priorities Forum (accessed March 2010)

Circumcision C03 Clinical Lerman SE, Liao J: Neonatal circumcision. Paediatric Clinics of “Statement on Male Circumcision”. Statement NWL Policy (D) NWL with (Blue) criteria North America 2001; 48: 1539-57 from the British Association of Paediatric exceptions Surgeons, The Royal College of Nursing, The ONEL Rickwood AMK. Medical indications for circumcision. Br J Urol Royal College of Paediatrics and Child Health, SEL with International 1999; 83(Suppl): 45-51 21 Procedure DFI Rationale Published evidence and reviews eg original studies, systematic Formal recommendations (NICE, professional Local review of Referral Comments Code category reviews, meta-analyses, journal articles, text books bodies, etc) evidence (by guidance sector or PCT)

Gatrad AR, Sheikh A, Jacks H. Religious circumcision and the The Royal College of Surgeons of England and SWL exceptions Human Rights Act. Arch Dis Child 2002; 86; 76-80 The Royal College of Anaesthetists. 6 March 2001. ONEL English Court of Appeal – Re J (Specific Issue Orders: Child's Religious Upbringing and Circumcision) Journal of Law and Med “The law and ethics of male circumcision - INEL 2000; 9: 68 -75 guidance for doctors” BMA, June 2006 SWL criteria Siegfried N, Muller M, Volmink J, Deeks J, Egger M, Low N, et al. Berkshire NHS Priorities Website (accessed NCL Male circumcision for prevention of heterosexual acquisition of HIV March 2009) in men. Cochrane Database of Systematic Reviews 2003, Issue 3. C&M (reqs Available at: discussion) http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/C D003362/pdf_fs.html [Accessed 2nd Oct 2007] West Essex Baillis SA, Halperin DT. Male circumcision: time to re-examine the Western evidence. Student BMJ 2006; 14: 179 Cheshire Ehman AJ. Cut circumcision from list of routine services, Saskatchewan MDs advised. CMAJ 2002; 167:532. Available at: 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 C04 Clinical O’Donoghue GM, Nikolopoulos TP, Archbold SM, Tait M. Speech NICE Technology Appraisal Guidance166. SWL SEL with Cost- implant criteria perception in children after cochlear implantation. American Journal Cochlear implants for children and adults with exceptions/ effectiveness? of Otolaryngology. 1998 Nov; 19 (6): 762-67. severe to profound deafness. Issue date January notification 2009. London at top SWL criteria national Summerfield AQ, Marshall DH. Cochlear quartile Implantation in the UK 1990-1994. Report by the NCL (Green) MRC Institute of Hearing research on the C&M criteria/ evaluation of the national cochlear implant 22 Procedure DFI Rationale Published evidence and reviews eg original studies, systematic Formal recommendations (NICE, professional Local review of Referral Comments Code category reviews, meta-analyses, journal articles, text books bodies, etc) evidence (by guidance sector or PCT)

programme. London: HMSO, 1995. exceptions Cochlear Implant and Bone Anchored Hearing West Sussex Aid Review Group. Provisional Report on the need for Cochlear Implant Surgery in Avon. RNID. Cochlear Implant Services - Commissioning Guidelines. 2007.

Dental C05 Clinical Meraw SJ et al. Analysis of surgical referral patterns for endosseous Royal College of Surgeons 1997 Guidelines for NWL Policy (D) NWL with Need to implants criteria dental implants. The International Journal of Oral and Maxillofacial Selecting Appropriate Patients To Receive exceptions review content Implants 14(2), 265-270, 1999. Treatment With Dental Implants: Priorities For of Consort The NHS INEL Group and Balshi TJ et al. Analysis of 356 pterygomaxillary implants in http://www.rcseng.ac.uk/dental/fds/pdf/ncg97.pdf SWL Scottish edentulous arches for fixed prosthesis anchorage. International Needs Journal of Oral and Maxilofacial Implants 14 (3), 398-406, 1999. The Consort Group, The Consort Statement: NCL Assessment revised recommendations for improving the Report Awad M A, Locker D, Korner-Bitensky N, Feine J S. Measuring the quality of reports of parallel group randomised effect of intra-oral implant rehabilitation on health related quality of trials 2001 http://www.consort-statement.org/ London at top life in a randomised controlled clinical trial. J Dent Res 2000; 79(9): national 1659-63. Scottish Needs Assessment Report. Dental quartile 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;12:129- 35. 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 890- 905. 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 C06 Clinical Bulstrode NW, Jemec B, Smith PJ. The complications of NICE Guidance CG34 (February 2004) ONEL SEL criteria/ (Blue) contracture criteria Dupuytren's contracture surgery. J Hand Surg [Am] 2005 notification Sep;30(5):1021-5. 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 Bird B, Ball C, Balasuntharam P. Rehabilitation after surgery for NCL Dupuytren’s Contracture. (Protocol) Cochrane Database of Brighton Systematic Reviews 2007, Issue 2. Revised Townley W A, Baker R, Sheppard N, Grobbelaar A O. Clinical Croydon list review: Dupuytren's contracture unfolded BMJ 2006;332:397- 400 (18 February) 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 C07 Clinical Thakar R, Stanton S. Management of genital prolapse. BMJ 2002; NICE CG40. Urinary incontinence - The Original (Blue) treatment criteria 324:1258-1262.2.18 management of urinary incontinence in women – Croydon list female genital October 2006 prolapse/ Jackson S, Smith P. Diagnosing and managing genitourinary stress prolapse. BMJ 1997;314:875-80. Bump RC, Cundiff GW. Pelvic organ prolapse. In: incontinence 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.continence- foundation.org.uk )

Hip C08 Clinical Scottish Arthroplasty project ONEL18 arthroplasty criteria

Suffolk

Hip C08a Clinical Alberta Bone and Joint Institute. Evidence Review: Appropriateness NICE. Guidance on the use of metal on metal hip SWL SWL criteria (Green) arthroplasty criteria Criteria for THA and TKA. Version 1: May 17,2006. resurfacing arthroplasty. Technology Appraisal Guidance No 44, 2002. Busato A; Roder C; Herren S; Eggli S Influence of high BMI on functional outcome after total hip arthroplasty. Obesity Surgery, May NICE. Consensus Development programme. Dec 2008, vol./is. 18/5(595-600), 0960-8923 2003 Dowsey MM; Choong PF. Obesity is a major risk factor for prosthetic Department of Health,2006. The Musculoskeletal infection after primary hip arthroplasty. Clinical Orthopaedics & Services Framework – A joint responsibility: doing Related Research, January 2008, vol./is. 466/1(153-8) it differently. 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 C08b Clinical resurfacing criteria

Hybrid hip C08c Clinical replacement criteria

Hip revision C09 Clinical Lubbeke A; Moons KG; Garavaglia G; Hoffmeyer P Outcomes of Scottish Arthroplasty project Suffolk criteria obese and non-obese patients undergoing revision total hip arthroplasty. Arthritis & Rheumatism, May 2008, vol./is. 59/5(738- 45), 0004-3591

Hip revision C09a Clinical criteria

18 ‘Hip surgery’ is on draft list, but evidence review and recommendations have not yet been written 25 Procedure DFI Rationale Published evidence and reviews eg original studies, systematic Formal recommendations (NICE, professional Local review of Referral Comments Code category reviews, meta-analyses, journal articles, text books bodies, etc) evidence (by guidance sector or PCT)

Hybrid hip C09b Clinical revision criteria

Knee C10 Clinical Scottish Arthroplasty project ONEL19 (Yellow) arthroplasty criteria Suffolk

Knee C10a Clinical Escobar A, Quintana JM, Arostehui I, Azkarate J, Güenaga, NHS Institute for Innovation and Improvement. SWL SWL criteria (Yellow) arthroplasty criteria Arenaza JC, Garai I. Development of explicit criteria for total knee Delivering Quality and Value. Focus on: replacement. International Journal of Technology Assessment in Productivity and Efficiency. 2006 Healthcare, 2003; 19: 57-70 Department of Health, 2006. The Musculoskeletal Field R et al. 11th European Forum on Quality in Health Care. Services Framework – A joint responsibility: doing it differently. Hawker G, Wright J, Coyte P et al. Health related quality of life after knee replacement . Results of the knee replacement patient NICE. Consensus Development programme. Dec outcomes research team study. J Bone Joint Surg Am 2003 1998;80A:163-803. 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 C10b Clinical (Yellow) arthroplasty criteria

19 On draft list as ‘knee procedure’, but evidence review and recommendations have not yet been written 26 Procedure DFI Rationale Published evidence and reviews eg original studies, systematic Formal recommendations (NICE, professional Local review of Referral Comments Code category reviews, meta-analyses, journal articles, text books bodies, etc) evidence (by guidance sector or PCT)

Knee revision C11 Clinical Scottish Arthroplasty project Suffolk (Yellow) criteria

Knee revision C11a Clinical (Yellow) criteria

Hybrid knee C11b Clinical (Yellow) revision criteria

Surgery for C12 Clinical Fazili, FM. To operate or not to operate on asymptomatic gallstone Norfolk asymptomatic criteria in laparoscopy, May 2010. On World Association of Laparoscopic gallstones Surgeons website. http://www.wals.org.uk/article.htm (review article)

Wisdom teeth C13 Clinical Hugoson A Kugelberg C F. The prevalence of third molars in a NICE Technology Appraisal TA 1. Guidance on ONEL ONEL20 (Green) extraction criteria Swedish population epidemiological study: Community Dental the Removal of Wisdom Teeth, March 2000 Health 1988:5; 121-138. SWL INEL ‘Management of Unerupted and Impacted Third Shepherd J P, Brickley M. Surgical removal of third molars. British Molar Teeth’, SIGN Publication No. 43, March SWL criteria Medical Journal 1994:309; 620-621 2000 NCL http://www.bmj.com/cgi/content/full/309/6955/620 http://www.sign.ac.uk/guidelines/fulltext/43/index. html C&M criteria Song F, Landes D P, Glenny A M. Sheldon T A. Prophylactic (req removal of impacted third molars: an assessment of published British Association of Oral Surgeons - ‘Removal discussion) reviews. British Dental Journal 1997:182(9):339 – 346. of wisdom teeth’ (accessed 1:10:08) http://www.baos.org.uk/info.cfm Toth B. The appropriateness of prophylactic extraction of impacted third molars: a review of the literature. Health Care Evaluation Unit, Royal College of Surgeons of England, Faculty of University of Bristol 1993. Dental Surgery, clinical guidelines, ‘The management of patients with third molar teeth’, Daley T D. Third molar prophylactic extractions: a review and 1997 analysis of the literature. General Dentistry 1996: 44(4); 310-320.

Cost-effective alternative

20 ‘Knee procedures’ are on draft list, but evidence review and recommendations have not yet been written 27 Procedure DFI Rationale Published evidence and reviews eg original studies, systematic Formal recommendations (NICE, professional Local review of Referral Comments Code category reviews, meta-analyses, journal articles, text books bodies, etc) evidence (by guidance sector or PCT)

Anal D01 Cost- Ly-Pen D, Andreu JL, de Blas G, Sanchez-Olaso A, Millan I. NICE Technology Appraisal TA 128. Stapled ONEL21 On original procedures effective Surgical decompression versus local steroid injection in carpal haemorrhoidopexy for the treatment of Croydon list – alternative tunnel syndrome: a one-year, prospective, randomized, open, haemorrhoids, Sep 2007 C&M criteria evidence controlled clinical trial. Arthritis Rheum 2005;52: 612-9 (req review not discussion) done J W H H Dammers, M M Veering, and M Vermeulen, Injection with methylprednisolone proximal to the carpal tunnel: randomised Norfolk (Green) 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 non- surgical 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. non- steroidal anti-inflammatory drug and splinting in carpal tunnel syndrome. Am J Phys Med Rehabil. 2002 Mar;81(3):182-6.

Carpal tunnel D02 Cost- Scholten RJPM, Mink van der Molen A, Uitdehaag BMJ, Bouter LM, ONEL ONEL procedures effective de Vet HCW. Surgical treatment options for carpal tunnel syndrome. alternative Cochrane Database of Systematic Reviews 2007, Issue 4. SEL notification Ly-Pen D, Andreu JL, de Blas G, Sanchez-Olaso A, Millan I. Surgical decompression versus local steroid injection in carpal INEL tunnel syndrome: a one-year, prospective, randomized, open, NCL controlled clinical trial. Arthritis Rheum 2005;52: 612-9

21 On draft list, but evidence review and recommendations have not yet been written 28 Procedure DFI Rationale Published evidence and reviews eg original studies, systematic Formal recommendations (NICE, professional Local review of Referral Comments Code category reviews, meta-analyses, journal articles, text books bodies, etc) evidence (by guidance sector or PCT)

J W H H Dammers, M M Veering, and M Vermeulen, Injection with C&M criteria methylprednisolone proximal to the carpal tunnel: randomised (req double blind trial BMJ 1999 319: 884-886. discussion) A.C.F. Hui, S. Wong, C. H. Leung, P. Tong, V. Mok, D. Poon, C. W. Revised Li-Tsang, L. K. Wong, and R. Boet. A randomized controlled trial of Croydon list surgery vs. steroid injection for carpal tunnel syndrome. Neurology, June 28, 2005; 64(12): 2074 - 2078. 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 non- surgical 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. non- steroidal anti-inflammatory drug and splinting in carpal tunnel syndrome. Am J Phys Med Rehabil. 2002 Mar;81(3):182-6.

Hyperhidrosis D03 Cost- Naumann M, Lowe NJ. Botulinum toxin type A in treatment of NWL Policy (D) NWL with Cost- treatment with effective bilateral primary axillary hyperhidrosis: randomised, parallel group, exceptions effectiveness botulinum alternative double blind, placebo controlled trial. BMJ 2001;323: 596 - ? compared to toxin INEL other Haidar A, Solish N. Focal hyperhidrosis: diagnosis and NCL treatment management. CMAJ 2005; 172: doi10.1503/cmaj.1040708. options is yet Available at: http://www.cmaj.ca/cgi/content/full/172/1/69 [Accessed to be 19th Sept 2007] established Vangelova L. Botulinum toxin: a poison that can heal. US Food and London at top Drug Administration. Available at: national www.fda.gov/fdac/features/095_bot.html [Accessed 19th Sept 2007] quartile International Hyperhidrosis Society. Hyperhidrosis treatment. Botulinum Toxin Injections (Botox®). Webpage. [Cited 19th Sept 29 Procedure DFI Rationale Published evidence and reviews eg original studies, systematic Formal recommendations (NICE, professional Local review of Referral Comments Code category reviews, meta-analyses, journal articles, text books bodies, etc) evidence (by guidance sector or PCT)

2007] Available at: www.sweathelp.org/English/HCP_Treatment_Botox.asp International Hyperhidrosis Society. Hyperhidrosis treatment. Botulinum Toxin Injections (Botox®): Safety. Webpage. [Cited 19th Sept 2007] http://www.sweathelp.org/English/HCP_Treatment_Botox_Safety.as p

Hysterectomy D04 Cost- Marjoribanks J, Lethaby A, Farquhar C. Surgery versus medical NICE CG44 Heavy menstrual bleeding: ONEL SEL with NWL does not for non- effective therapy for heavy menstrual bleeding. Cochrane Database of investigation and treatment – Jan 2007 exceptions/ include cancerous alternative Systematic Reviews 2006, Issue 2. SWL notification heavy Royal College of Obstetricians and (Blue) menstrual Nieboer TE, Johnson N, Barlow D, Lethaby A, Tavender E, Curr E, Gynaecologists (1999). Management of ONEL bleeding Garry R, van Voorst S, Mol BWJ, Kluivers K. Surgical approach to Menorrhagia in Secondary Care hysterectomy for benign gynaecological disease. Cochrane INEL Database of Systematic Reviews 2006, Issue 2. SWL criteria NCL C&M criteria (req discussion) NWL/Brent West Essex Berkshire

Hysteroscopy D05 Cost- NICE CG44 Heavy menstrual bleeding: Norfolk (Green) effective investigation and treatment – Jan 2007 alternative Suffolk

Cancelled E01 Cancelled Not applicable Not applicable Not applicable procedures procedures