Evaluation of the methodological quality of the Health Protection Agency's 2009 guidance on neuraminidase inhibitors

Background The Health Protection Agency (HPA) issued guidance advocating the prescription of neuraminidase inhibitors in July 2009 in response to a predicted pandemic of influenza. Although the contents of the guidance have been debated, the methodology has not. Method The guidance was evaluated by two reviewers using a validated and internationally recognised tool for assessing guidelines, the Appraisal of Guidelines Research & Evaluation instrument (AGREE). This tool scores six domains independently of each other. Results The guidance scored 61% for the domain scope and purpose and 54% for the domain clarity and presentation. By contrast, it scored only 31% for rigour of development due to poor linkage of its recommendations to evidence. Conclusion The HPA should improve its performance in this domain to general practitioners in order to improve the credibility of its future guidance.