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Cilostazol in NICE guideline
  1. Sergi Bellmunt,
  2. Pere N Roset,
  3. Jose R Escudero
  1. Servicio de Angiologia, Cirugia Vascular y Endovascular, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
  1. Correspondence to Dr Sergi Bellmunt, Servicio de Angiologia, Hospital de la Santa Creu i Sant Pau, Sant antoni Maria i Claret 167, Barcelona, Catalunya 08025, Spain; sbellmunt{at}

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To the Editor Shalhoub and Davies1 commented in their summary of the National Institute for Health and Clinical Excellence (NICE) guidance on cilostazol, naftidrofyryl oxalate, pentoxifylline and inositol nicotinate for the treatment of intermittent claudication (NICE technology appraisal guidance 223; available at: that the cost-effectiveness analysis was based on appropriate assumptions; however, this analysis was based on a meta-analysis plagued with uncertainties.2 In this evaluation, Squires et al2 systematically reviewed all randomised clinical trials for these drugs and obtained pooled estimates for several outcomes, including maximum walking distance (MWD).

As Squires and coworkers2 point out in their report, cost-effectiveness analysis needs to be based on quality-adjusted life years gained with treatment. As no evidence was found that any of these drugs could modify disease-related morbidity or mortality, the …

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    Joseph Shalhoub Alun H Davies