NICE acknowledged earlier this year that poor evidence on cost-effectiveness would limit its ability to review indicators.

Much of the evidence used to assess them so far has been merely expert opinion, according to QOF statistics expert and Wiltshire GP Dr Gavin Jamie.

The review committee was ‘pretty scathing' about even the indicators it chose to put forward for negotiation, Dr Jamie said. Many other indicator proposals from charities and other organisations were ‘sent back for more work'.

Poor evidence has been a particular problem for cost-effectiveness assessments, Dr Jamie believes. ‘The cost-effectiveness documents are a bit of a disaster,' he said. ‘In the new epilepsy indicator there is no cost-benefit evidence offered and it is pretty thin for the Down's TSH indicator,' he said.

NICE documents acknowledge that cost-effectiveness evidence is 'modest' for the epilepsy indicator and that no such evidence is available for the Down's syndrome indicator.

• Read the full story in this week's GP dated 11 September.