NICE's QOF review committee is facing criticism for proposing indicators with too little evidence of effectiveness, while rejecting others well supported by evidence.
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.
'The indicators it put on the menu have tended to be very minor, certainly in terms of patient numbers. I wonder if there was pressure, perceived or real, to put something on the menu.'
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.
The review committee has also been criticised for rejecting an indicator assessing structured education for people with diabetes. NICE guidelines and technology appraisals back a similar approach, but the indicator was rejected on the basis of a lack of UK-based evidence.
Stella Valerkou, senior policy officer at Diabetes UK, said UK examples of effective education schemes were available.
'NICE has already identified the importance of structured education for people with type-1 and type-2 diabetes with both the technology appraisal and recommendations in clinical guidelines,' she added.