Changes

May 2025 — minor update. QOF indicators updated in line with the NHS England Quality and Outcomes Framework guidance for 2025/26.

Update

Goals

To support primary healthcare professionals to:

• Identify people with problem drinking.
• Help the person reduce or stop drinking, so that harm is prevented, or risk of harm is reduced.
• Refer or admit, when appropriate, for specialist assessment, treatment, and ongoing modification of problem drinking behaviour.
• Encourage continued abstinence when possible and appropriate.

Outcome measures

No outcome measures were found during the review of this topic.

Audit criteria

QOF indicators

Table 1. Indicators from the Quality and Outcomes Framework (QOF) for asthma in the General Medical Services (GMS) contract.

QIPP - Options for local implementation

No QIPP indicators were found during the review of this topic.

NICE quality standards

Alcohol-use disorders: diagnosis and management

• Adults who are being asked about their alcohol use have a validated alcohol questionnaire completed to identify any need for a brief intervention or referral to specialist alcohol services. 
• Adults seeking help for an alcohol-use disorder are given information on, and support to access, community support networks and self-help groups.
• Adults accessing specialist alcohol services have a brief triage assessment that includes any treatment needs and associated risks.
• Adults in acute alcohol withdrawal in hospital are assessed and monitored following locally specified protocols.
• Adults with moderate or severe alcohol dependence are offered psychological and, if appropriate, pharmacological interventions to prevent relapse following a successful unplanned withdrawal in hospital. 

[NICE, 2023]

Fetal alcohol spectrum disorder

• Pregnant women are given advice throughout pregnancy not to drink alcohol.
• Pregnant women are asked about their alcohol use throughout their pregnancy and this is recorded.
• Children and young people with probable prenatal alcohol exposure and significant physical, developmental, or behavioural difficulties are referred for assessment.
• Children and young people with confirmed prenatal alcohol exposure or all 3 facial features associated with prenatal alcohol exposure have a neurodevelopmental assessment, if there are clinical concerns.
• Children and young people with a diagnosis of fetal alcohol spectrum disorder (FASD) have a management plan to address their needs.

[NICE, 2022c]

Coexisting severe mental illness and substance misuse

• People aged 14 and over with suspected or confirmed severe mental illness are asked about their use of alcohol and drugs.
• People aged 14 and over are not excluded from mental health services because of coexisting substance misuse or from substance misuse services because of coexisting severe mental illness.
• People aged 14 and over with coexisting severe mental illness and substance misuse have a care coordinator working in mental health services when they are identified as needing treatment from secondary care mental health services.
• People aged 14 and over with coexisting severe mental illness and substance misuse are followed up if they miss any appointment.

[NICE, 2019]

What is it?

• Problem alcohol use is defined as exceeding low-risk drinking guidelines.
• The Chief Medical Officer's low risk drinking guideline advises that [DH, 2016]:
  
  • It is safest for both men and women not to drink more than 14 units a week on a regular basis.
  • People who drink as much as 14 units per week should spread this evenly over 3 days or more. 
  • During pregnancy, the safest approach is to avoid drinking alcohol. 
• Hazardous (increasing risk) drinking is a pattern of alcohol consumption that increases a person's risk of harm:  
  • Drinking more than 14 units of alcohol a week, but less than 35 units a week for women.
  • Drinking more than 14 units of alcohol a week, but less than 50 units a week for men. 
• Alcohol-use disorder (AUD) encompasses both:
  • Harmful (higher-risk) drinking — this is a pattern of alcohol consumption causing health problems directly related to alcohol. It could include psychological problems (such as depression), alcohol-related accidents, or physical illness (such as acute pancreatitis). 
    • In the longer term, harmful drinkers may go on to develop high blood pressure, cirrhosis, heart disease, and some types of cancer (such as mouth, liver, bowel, or breast cancer).
  • Alcohol dependence — this is characterized by craving, tolerance, a preoccupation with alcohol, and continued drinking in spite of harmful consequences (for example, liver disease or depression caused by drinking). 
• The Diagnostic and Statistical Manual of Mental Disorders Text Revision (DSM-5-TR) defines AUD as a problematic pattern of alcohol use leading to clinically significant impairment or distress, when manifested by at least two of the following, occurring within a 12-month period [APA, 2022]:
  • Alcohol is often taken in larger amounts or over a longer period than was intended.
  • There is a persistent desire, or unsuccessful efforts, to cut down or control alcohol use.
  • A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
  • Craving, or a strong desire or urge to use alcohol.
  • Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
  • Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
  • Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
  • Recurrent alcohol use in situations in which it is physically hazardous.
  • Alcohol use is continued, despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
  • Tolerance, as defined by either of the following:
    • A need for markedly increased amounts of alcohol to achieve intoxication or the desired effect.
    • A markedly diminished effect with continued use of the same amount of alcohol.
  • Withdrawal, as manifested by either of the following:
    • The characteristic withdrawal syndrome for alcohol. 
    • Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.
• AUD can be:
  • Mild — 2 to 3 symptoms
  • Moderate — 4 to 5 symptoms.
  • Severe — 6 or more symptoms. 

[DH, 2016; APA, 2022; NICE, 2011a] 

How common is it?

• Around 21% of the adult population in England, and 24% of adults in England and Scotland, regularly drink at levels that increase their risk of ill health [DHSC, 2021]. 
  • In England in 2018, over twice as many men than women drank at levels of increasing risk in a usual week (25% and 11% respectively). Similarly, at higher risk levels 5% of men drank over 50 units and 3% of women drank over 35 units. 
    • However, the disorder is probably under-reported in females [BMJ, 2018].
  • Adults living in the least deprived areas are more likely to drink over 14 units of alcohol in a usual week than those living in the most deprived areas (27% compared with 18%). 
• In 2018 to 2019, there were an estimated 602,391 adults in England with alcohol dependency [PHE, 2021a].  
• In 2020 to 2021, 76,740 adults in England were in treatment for alcohol use, and 30,688 for alcohol and non-opiate drug use [OHID, 2021]. 
• Alcohol-use disorder is a common psychiatric disorder with lifetime prevalence estimates of 7-10% in most Western countries [BMJ, 2018]. 
  • In primary care settings, the prevalence of alcohol-use disorders ranges from 20-36%. 
• Alcohol consumption patterns have changed since the COVID-19 pandemic [ONS, 2021] — lighter drinkers decreased consumption during the pandemic, but heavy drinkers increased consumption [Angus, 2022]. 
  • This was greatest among men and people in the highest socioeconomic groups, with the largest increase in consumption in people aged 25-34 years who were drinking at risky levels before the pandemic.
  • A Public Health England report on alcohol consumption and harm during the COVID-19 pandemic found that [PHE, 2021b]: 
    • In 2020 (during the pandemic), there were 6,983 alcohol-specific deaths, an increase of 20% compared to 2019 (before the pandemic), when there were 5,819 deaths. The rate of all alcohol-specific deaths peaked in December at 14 per 100,000 — more than a 50% increase for the same month compared to the baseline rate of 9.3 per 100,000.
    • In emerging 2021 data, alcohol-specific deaths reached a peak of 15 per 100,000 in March — a 42.9% increase compared to the same month in the baseline data (10.5 per 100,000 population).

What are the complications?

• Alcohol is the leading risk factor globally for disability-adjusted life years (DALYs) for people aged 15 to 49 years. 
  • It costs society around £7 billion in lost productivity through unemployment and sickness, as well as £3.5 billion to the NHS. 
  • In 2020, there were 8,974 deaths (14 per 100,000 people) from alcohol-specific causes registered in the UK, an 18.6% increase compared with 2019 (7,565 deaths; 11.8 per 100,000 people) and the highest year-on-year increase since the data time series began in 2001. 
    • The North East of England had the highest rates of any English region at 20 deaths per 100,000 people. 
  • The rate of alcohol-specific deaths for males in 2020 remained more than double the rate for females (19 and 9.2 deaths per 100,000 people respectively). 
  • Scotland and Northern Ireland had the highest rates of alcohol-specific deaths in 2020 (21.5 and 19.6 deaths per 100,000 people respectively). 
• Specific health complications relating to alcohol misuse include:
  • Short term harm — death and illness from accident and injury, drowning, alcohol poisoning, and self-harm related to alcohol.
    • The risks of injury to a person who has been drinking recently rises between two and five times when 5-7 units are drunk in a 3-6 hour period. 
    • In 2020, deaths from alcohol poisoning accounted for 6.3% of total alcohol-specific deaths. 
    • In 2020 (during the COVID-19 pandemic) there was a 15.4% increase in alcohol poisoning deaths, from 384 to 443 deaths compared to 2019 (before the COVID-19 pandemic). In contrast, between 2018 and 2019 there was a decrease of 4.5%.
  • Long term harm — death and illness from:
    • Cancer — such as mouth, throat, bowel, stomach, liver, and breast cancer.  
    • Heart disease, cardiac arrhythmia, hypertensive disease — alcoholic cardiomyopathy is characterised by cardiomegaly, disruptions of myofibrillary architecture, reduced myocardial contractility, decreased ejection fraction, and enhanced risk of stroke and hypertension. 
    • Alcoholic liver disease, liver cirrhosis — the three conditions most associated with alcohol use are fatty liver (steatosis), hepatitis (acute and chronic), and cirrhosis. These conditions can occur separately or concurrently. Women drinkers are at higher risk of developing alcohol-related liver disease, due to their lower ability to metabolize alcohol. Alcoholic cirrhosis is the most common cause of liver cirrhosis in the Western world. It is associated with a significant increase in risk of death due to bleeding oesophageal varices, infection, renal failure, and/or hepatic failure. 
    • Pancreatitis (acute, or chronic) — alcohol causes 40-45% of cases of acute pancreatitis and is the most common cause of acute pancreatitis in men. There is no threshold for the development of acute pancreatitis. Chronic pancreatitis is characterised by reduced pancreatic exocrine function, malabsorption, diabetes, and pancreatic calcifications. Worldwide, alcohol is the major risk factor for chronic pancreatitis (70-80%). 
    • Psychiatric illness — an estimated 44% of community mental health patients report problem drug use, or harmful alcohol, use in the previous year. The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness found that there was a history of alcohol misuse in 45% of suicides among the patient population during the period of 2002 to 2011.
    • Wernicke-Korsakoff syndrome — alcohol-use disorder is often associated with a thiamine deficiency which, if severe, may lead to Wernicke's encephalopathy. This is characterised by ocular motility disorders, ataxia, and confusion. When people with Wernicke's encephalopathy are inappropriately treated with low doses of thiamine, mortality rates average about 20%, and Korsakoff's psychosis develops in about 85% of survivors. Korsakoff's psychosis is characterised by anterograde and retrograde amnesia, disorientation, and confabulation. 
• Alcohol consumption during pregnancy can adversely affect the fetus. 
  • Fetal alcohol exposure has been associated with miscarriage, stillbirth, and preterm delivery.
  • Fetal alcohol spectrum disorders (FASD) encompasses a continuum of adverse physical and neurodevelopmental outcomes following prenatal alcohol exposure. The most severe is fetal alcohol syndrome (FAS) which is associated with chronic high (more than 5 units a day) alcohol consumption during pregnancy. Features of FASD include: 
    • Pre- and postnatal growth deficiency.
    • Characteristic facial features — at least two of the following: short palpebral fissures, smooth/indistinct philtrum, or thin vermilion border of upper lip. 
    • Central nervous system abnormalities — these can manifest as a range of neurobehavioral problems. 
    • Deficient brain growth, abnormal morphogenesis, or abnormal neurophysiology. 
  • Studies of lower levels of consumption can be difficult to interpret, and while the risks are probably low, it cannot be certain that it is completely safe. Therefore, the Department of Health recommends that pregnant women avoid alcohol completely. 
• Social complications relating to alcohol misuse include family conflict and domestic violence and abuse.
  • Alcohol plays a part in 25-33% of known cases of child abuse, and is a factor in 16% of child in need cases. 
  • In a study of four London boroughs, almost two-thirds of all children subject to care proceedings had parents who misused substances including alcohol.
  • In a study of young offending cases where the young person was also misusing alcohol, 78% had a history of parental alcohol abuse or domestic abuse within the family.
  • Data from 2009 to 2010 and 2019 to 2020 suggest that between 24-39% of victims of domestic abuse believe the offender was under the influence of alcohol. 

[DH, 2016; PHE, 2016; BMJ, 2018; UKTIS, 2019; ONS, 2021; PHE, 2021b; PHE, 2021c; BMJ, 2022a; GBD, 2022] 

What is the prognosis?

• People with harmful or problem alcohol use may benefit greatly from brief intervention, reducing their alcohol use substantially or initiating abstinence. However, a minority will eventually meet the criteria for alcohol dependence. 
• Alcohol-use disorder (AUD), particularly when chronic and severe, can be associated with a variety of medical and psychiatric complications. 
  • Among people aged 15 to 49 years, alcohol is the leading cause of ill-health, disability, and death.
  • In 2017 to 2018, there were over 1.1 million hospital admissions related to alcohol — alcohol was the main reason for admission in approximately 338,000 cases. 
• AUD is usually chronic, and while treatment is beneficial, relapse is common, particularly in the first 12 months after starting treatment. 
• AUD may progress from impulsivity to compulsivity — chronic exposure of the brain to alcohol is thought to result in long-term adaptive changes that initially produce increased reinforcement for alcohol use, and over time progress to withdrawal and negative affective states, so that regular alcohol use is required to feel normal. 

[BMJ, 2018; DHSC, 2021; OHID, 2022]

Who should I screen for problem drinking?

• Routinely carry out alcohol screening as an integral part of practice in primary care. For example, when: 
  • Registering a new patient. 
  • Screening for other conditions. 
  • Managing a chronic disease (for example, diabetes, hypertension, or chronic heart disease). 
  • Carrying out a medication review. 
  • Promoting sexual health.
  • Seeing someone for an antenatal appointment.
  • Treating minor injuries.
• If screening everyone is not feasible or practicable, focus on people who have an alcohol-related condition or who are at increased risk of harm from alcohol. This includes people: 
  • With relevant physical conditions (such as hypertension, gastrointestinal disorders, or liver disorders).
  • With relevant mental health problems (such as anxiety, depression, gambling-related harms, or other mood disorders).
  • Who have been assaulted.
  • At risk of self-harm.
  • Who regularly experience accidents or minor traumas.
  • Who regularly attend genito-urinary medicine clinics or seek emergency contraception.
• Always screen people who make an active call for help, or in whom an alcohol problem is strongly indicated as an incidental finding.
  • An active request for help (either from the person, or through friends or relatives) is more likely in people with harmful drinking or alcohol dependence. People who are drinking levels below this but above the low risk drinking guidelines will not usually seek medical help, even though they may be aware that their drinking is putting them at risk.
  • Incidental findings that raise suspicion of problem drinking may include:
    • Abnormal blood tests such as a raised gamma-glutamyl transferase (GGT) and mean corpuscular volume (MCV).
    • Signs of an alcohol problem, such as dilated facial capillaries, bloodshot eyes, or hand tremor.
    • Symptoms suggestive of a possible alcohol problem — professionals should be aware of the complications and comorbid diseases associated with an alcohol problem, or have a raised suspicion of an alcohol problem based on an individual's behaviour (for example use of illicit drugs, smelling of alcohol in consultations, numerous accidents, or requesting numerous sick notes). Recognizing these cues should initiate further questioning and the opportunistic (targeted) detection of a potential alcohol problem.

How should I screen for problem drinking?

• Tailor discussions on alcohol and screening according to the person's needs.
  • Take into account that stigma and discrimination are often associated with alcohol misuse, and that minimising the problem may be part of the presentation. 
  • Make sure that discussions take place in settings in which confidentiality, privacy, and dignity are respected. 
• Use the AUDIT (Alcohol Use Disorders Identification Test) questionnaire to routinely assess the nature and severity of alcohol misuse. AUDIT scores are interpreted as: 
  • 0-7 indicates low-risk.
  • 8-15 indicates increasing risk. 
  • 16-19 indicates higher risk. 
  • 20 or more indicates possible dependence. 
• Use clinical judgement to decide whether AUDIT cut-offs should be revised downwards (that is to increase sensitivity) when screening women (including those who are, or plan to become, pregnant), people aged 65 years and older, and people from some black and minority ethnic groups. If there is any doubt, or an English language-based screening questionnaire is not appropriate, seek specialist advice. 
• The AUDIT PC questionnaire consists of 5 questions from AUDIT and is designed to be used in primary care where time is limited. 
  • A total of 5 or more is a positive screen, indicating increasing or higher risk drinking. If time permits, complete the remaining AUDIT questions to obtain a full score. 
• The AUDIT-C questionnaire consists of the first 3 questions from AUDIT and can be used where time is limited.
  • If the score is 5 or more, and time permits, complete the remaining AUDIT questions to obtain a full score. 
• If the result of the AUDIT questionnaire suggests alcohol dependence, consider assessing the severity using the SADQ (Severity of Alcohol Dependence Questionnaire) or LDQ (Leeds Dependence Questionnaire). 
  • Cut-offs for the SADQ are as followed: 15 or less — mild dependence, 15 to 30 — moderate dependence, 31 or more — severe dependence. 
  • Cut-offs for the LDQ are as followed: 1 to 10 — low/moderate dependence, 11 to 20 — moderate/high dependence, 21 or more — high dependence. 
• Be aware of symptoms of alcohol withdrawal.
• Note: Blood tests should not be used routinely to detect whether a person has been misusing alcohol. However, they may help identify physical health needs relating to alcohol use.

Scenario: Alcohol misuse

From age 18 years onwards.

Thiamine

Acamprosate

Search strategy

Scope of search

A full literature search was not requested as this CKS topic is primarily based on the National Institute for Health and Care Excellence (NICE) guidelines Alcohol-use disorders: diagnosis and clinical management of alcohol-related physical complications and Alcohol-use disorders: preventing the development of hazardous and harmful drinking.

Search dates

December 2017 - November 2022

Key search terms

Various combinations of searches were carried out. The terms listed below are the core search terms that were used for Medline.

• exp alcohol/, alcohol$.tw,

Sources of guidelines

• National Institute for Health and Care Excellence (NICE)
• Scottish Intercollegiate Guidelines Network (SIGN)
• Royal College of Physicians
• Royal College of General Practitioners
• Royal College of Nursing
• NICE Evidence
• World Health Organization
• Guidelines International Network
• TRIP database
• Agency for Healthcare Research and Quality
• National Health and Medical Research Council (Australia)
• Royal Australian College of General Practitioners
• British Columbia Medical Association
• Canadian Medical Association
• Alberta Medical Association
• Michigan Quality Improvement Consortium
• Singapore Ministry of Health
• National Resource for Infection Control
• RefHELP NHS Lothian Referral Guidelines
• Medline (with guideline filter)
• Driver and Vehicle Licensing Agency
• NHS Health at Work (occupational health practice)

Sources of systematic reviews and meta-analyses

• The Cochrane Library:
  • Systematic reviews
  • Protocols
  • Database of Abstracts of Reviews of Effects
• Medline (with systematic review filter)
• EMBASE (with systematic review filter)

Sources of health technology assessments and economic appraisals

• NIHR Health Technology Assessment programme
• The Cochrane Library:
  • NHS Economic Evaluations
  • Health Technology Assessments
• Canadian Agency for Drugs and Technologies in Health
• International Network of Agencies for Health Technology Assessment

Sources of randomized controlled trials

• The Cochrane Library:
  • Central Register of Controlled Trials
• Medline (with randomized controlled trial filter)
• EMBASE (with randomized controlled trial filter)

Sources of evidence based reviews and evidence summaries

• Drug and Therapeutics Bulletin
• TRIP database
• Central Services Agency COMPASS Therapeutic Notes

Sources of national policy

• Department of Health
• Health Management Information Consortium (HMIC)

Patient experiences

• Healthtalk
• BMJ - Patient Journeys

Sources of medicines information

The following sources are used by CKS pharmacists and are not necessarily searched by CKS information specialists for all topics. Some of these resources are not freely available and require subscriptions to access content.

• British National Formulary (BNF)
• electronic Medicines Compendium (eMC)
• European Medicines Agency (EMEA)
• Medicines and Healthcare products Regulatory Agency (MHRA)
• REPROTOX
• Scottish Medicines Consortium
• Stockley's Drug Interactions
• TERIS
• TOXBASE
• Micromedex
• UK Medicines Information

Stakeholder engagement

Our policy

The external review process is an essential part of CKS topic development. Consultation with a wide range of stakeholders provides quality assurance of the topic in terms of:

• Clinical accuracy.
• Consistency with other providers of clinical knowledge for primary care.
• Accuracy of implementation of national guidance (in particular NICE guidelines).
• Usability.

Principles of the consultation process

• The process is inclusive and any individual may participate.
• To participate, an individual must declare whether they have any competing interests or not. If they do not declare whether or not they have competing interests, their comments will not be considered.
• Comments received after the deadline will be considered, but they may not be acted upon before the clinical topic is issued onto the website.
• Comments are accepted in any format that is convenient to the reviewer, although an electronic format is encouraged.
• External reviewers are not paid for commenting on the draft topics.
• Discussion with an individual or an organization about the CKS response to their comments is only undertaken in exceptional circumstances (at the discretion of the Clinical Editor or Editorial Steering Group).
• All reviewers are thanked and offered a letter acknowledging their contribution for the purposes of appraisal/revalidation.
• All reviewers are invited to be acknowledged on the website. All reviewers are given the opportunity to feedback about the external review process, enabling improvements to be made where appropriate.

Stakeholders

• Key stakeholders identified by the CKS team are invited to comment on draft CKS topics. Individuals and organizations can also register an interest to feedback on a specific topic, or topics in a particular clinical area, through the Getting involved section of the Clarity Informatics website.
• Stakeholders identified from the following groups are invited to review draft topics:
  • Experts in the topic area.
  • Professional organizations and societies (for example, Royal Colleges).
  • Patient organizations, Clarity has established close links with groups such as Age UK and the Alzheimer’s Society specifically for their input into new topic development, review of current topic content and advice on relevant areas of expert knowledge.
  • Guideline development groups where the topic is an implementation of a guideline.
  • The British National Formulary team.
  • The editorial team that develop MeReC Publications.
• Reviewers are provided with clear instructions about what to review, what comments are particularly helpful, how to submit comments, and declaring interests.

Patient engagement

Clarity Informatics has enlisted the support and involvement of patients and lay persons at all stages in the process of creating the content which include:

• Topic selection
• Scoping of topic
• Selection of clinical scenarios
• First draft internal review
• Second draft internal review
• External review
• Final draft and pre-publication

Our lay and patient involvement includes membership on the editorial steering group, contacting expert patient groups, organizations and individuals.

Evidence exclusion criteria

Our policy

Scoping a literature search, and reviewing the evidence for CKS is a methodical and systematic process that is carried out by the lead clinical author for each topic. Relevant evidence is gathered in order that the clinical author can make fully informed decisions and recommendations. It is important to note that some evidence may be excluded for a variety of reasons. These reasons may be applied across all CKS topics or may be specific to a given topic.

Studies identified during literature searches are reviewed to identify the most appropriate information to author a CKS topic, ensuring any recommendations are based on the best evidence. We use the principles of the GRADE and PICOT approaches to assess the quality of published research. We use the principles of AGREE II to assess the quality of published guidelines.

Standard exclusions for scoping literature:

• Animal studies
• Original research is not written in English

Possible exclusions for reviewed literature:

• Sample size too small or study underpowered
• Bias evident or promotional literature
• Population not relevant
• Intervention/treatment not relevant
• Outcomes not relevant
• Outcomes have no clear evidence of clinical effectiveness
• Setting not relevant
• Not relevant to UK
• Incorrect study type
• Review article
• Duplicate reference

Organizational, behavioural and financial barriers

Our policy

The CKS literature searches take into consideration the following concepts, which are discussed at the initial scoping of the topic.

• Feasibility
  • Studies are selected depending on whether the intervention under investigation is available in the NHS and can be practically and safely undertaken in primary care.
• Organizational and Financial Impact Analysis
• Studies are selected and evaluated on whether the intervention under investigations may have an impact on local clinical service provision or national impact on cost for the NHS. The principles of clinical budget impact analysis are adhered to, evaluated and recorded by the author. The following factors are considered when making this assessment and analysis.
  • Eligible population
  • Current interventions
  • Likely uptake of new intervention or recommendation
  • Cost of the current or new intervention mix
  • Impact on other costs
  • Condition-related costs
  • In-direct costs and service impacts
  • Time dependencies
• Cost-effectiveness or cost-benefit analysis studies are identified where available. 

We also evaluate and include evidence from NICE accredited sources which provide economic evaluations of recommendations, such as NICE guidelines. When a recommended action may not be possible because of resource constraints, this is explicitly indicated to healthcare professionals by the wording of the CKS recommendation.

Declarations of interest

Our policy

Clarity Informatics requests that all those involved in the writing and reviewing of topics, and those involved in the external review process to declare any competing interests. Signed copies are securely held by Clarity Informatics and are available on request with the permission of the individual. A copy of the declaration of interest form which participants are asked to complete annually is also available on request. A brief outline of the declarations of interest policy is described here and full details of the policy is available on the Clarity Informatics website. Declarations of interests of the authors are not routinely published, however competing interests of all those involved in the topic update or development are listed below. Competing interests include:

• Personal financial interests
• Personal family interest
• Personal non-financial interest
• Non-personal financial gain or benefit

Although particular attention is given to interests that could result in financial gains or losses for the individual, competing interests may also arise from academic competition or for political, personal, religious, and reputational reasons. An individual is not obliged to seek out knowledge of work done for, or on behalf of, the healthcare industry within the departments for which they are responsible if they would not normally expect to be informed.

Who should declare competing interests?

Any individual (or organization) involved in developing, reviewing, or commenting on clinical content, particularly the recommendations should declare competing interests. This includes the authoring team members, expert advisers, external reviewers of draft topics, individuals providing feedback on published topics, and Editorial Steering Group members. Declarations of interest are completed annually for authoring team and editorial steering group members, and are completed at the start of the topic update and development process for external stakeholders.

Competing interests declared for this topic:

None.