Background: In England, demands on the health and social-care services have increased significantly, while funding has not increased to match these demands. To help ensure the best use of limited resources, NICE’s Board now requires that resource-impact considerations should inform how Guideline Committees make recommendations.

Objectives: To describe how consideration of resource impact in addition to cost-effectiveness has influenced decision making within NICE guidelines.

Methods:The following guidance has been developed by the NICE Resource Impact team with input from those commissioning services:
• Resource impact should be considered for each of the first 5 years of implementing the guideline.
• Resource impact is defined as substantial if:
o the resource impact of implementing a guideline recommendation in England is more than £1m per year, or
o the resource impact of implementing the whole guideline in England is more than £5m per year.

In addition, the following practical steps and principles have been developed to support guideline committees:
• identifying and prioritising areas that have the potential to result in substantial cost increases during guideline development for economic analysis;
• providing information on likely costs earlier in the guideline-development process;
• recognising that cost pressures should not be introduced into the system unless the committee is convinced of the benefits of the recommendation;
• requiring that economic analysis must be undertaken if committees wish to make recommendations that are anticipated to substantially increase costs; and,
• engaging with stakeholders regarding resource impact.

Results: We will describe how these processes have been applied to a real NICE guideline. We will articulate the distinction in methods between cost-effectiveness and resource-impact analyses, as well as discussing how these elements are considered and balanced in the decision making of the committee.

Conclusions: There is now a greater need for NICE Guideline Committees to be rigorous and explicit in considering and communicating the underpinning economic evidence and case for investment.