National guidance and allocation of resources

EDITOR-I think that Cookson et al in their criticisms of the Scottish Intercollegiate Guidelines Network (SIGN) show a lack of understanding of the role of this organisation and the methods it uses to develop its guidelines. 1 Evidence based guidelines will not resolve all healthcare issues, just as randomised controlled trials are not appropriate to resolve all therapeutic controversies. Feb 1, 2002 EDITOR-One of the greatest strengths of economists lies in drawing inferences from imperfect data, and, as Maynard knows, the data about the value of reducing risk of hospital acquired infection are certainly imperfect. 1 2 Cookson et al dismissed guideline 45 from the Scottish Intercollegiate Guidelines Network (SIGN) as a calculation done on the back of the envelope, about the budgetary impact of antibiotic prophylaxis for surgery. 3 The guideline provides two decision rules that challenge policymakers to identify a point at which antibiotic prophylaxis may be effective but not cost effective.