A framework for incorporating cost-effectiveness in evidence-based clinical practice guidelines.
In England, recent health care reforms emphasise the role of clinical guidelines in promoting effective and efficient health care. Introducing economic data into guidelines raises some methodological issues: specifically, the provision of valid and generalisable cost estimates, the weight placed upon cost 'evidence', and the presentation of cost-effectiveness information in a manner accessible to clinicians. A series of primary care guidelines, explicitly including consideration of health economic information, have recently been published, intended to help clinicians to aggregate the attributes of treatment choices to derive treatment recommendations consistent with both the clinical decision-making process and social objectives. Clinicians involved in developing guidelines responded well to the process and consistently managed to agree treatment recommendations, often after considerable debate about the evidence for treatment. In none of the guideline areas, all of which addressed common diseases, was there adequate information to estimate a cost per quality-adjusted-life-year, and it is unclear how helpful this approach would have been had it been possible. The implications of this method are discussed, guidance offered for economists new to guideline development and future areas of work identified.
Mason
J
J
Medicines Evaluation Group Centre for Health Economics, University of York, Heslington, UK. jmm7@york.ac.uk
Eccles
M
M
Freemantle
N
N
Drummond
M
M
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002303:Cardiac Output, Low / Q000188:drug therapy; D003363:Cost Control; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine / Q000191:economics*; D018166:Health Care Reform; D006801:Humans; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D019057:Quality-Adjusted Life Years; D006113:United Kingdom
D000806:Angiotensin-Converting Enzyme Inhibitors