Economic analysis for clinical practice--the case of 31 national consensus guidelines in the Netherlands.
OBJECTIVE
Evidence on the cost-effectiveness of health interventions in the development of practice guidelines has become of interest in many countries. Challenges are the quality of economic data, the use of cost-effectiveness criteria, and the consensus process. Our paper aims to assess the quality and use of economic information in the formulation of consensus guidelines in a Dutch pilot programme and to recommend improvements.


METHODS
Retrospective qualitative review of economic evaluations and formulated recommendations, using a checklist based on international standards.


RESULTS
The national programme to support the development of guidelines with economic analysis in multidisciplinary consensus groups run from 1998 to 2002. It has included 31 medical guidelines, addressing 23 conditions across seven International Classification of Diseases (ICD)-disease groups. Experts in health technology assessment have participated in the guidelines groups. Economic information in all guidelines varies by all criteria in the level of evidence used. Information on quality-adjusted life years gained is limited as is statistical analysis in most studies. Highest cost-effectiveness ratios reported are between Euros 20,000 and Euros 30,000. However, there is no uniformity in the definitions of acceptable cost-effectiveness ratios.


CONCLUSIONS
Economic recommendations can be included in guidelines. Interaction between clinicians and health economists promotes a balance between medical and economic arguments. Among panellists there appears to be agreement on the level of the cost-effectiveness ratios that is acceptable. It is recommended that economic analysis is used to strengthen the evidence-base of guidelines. An evidence-grading system should include the quality of economic evaluation. Roles of policymakers and providers need to be defined.
Niessen
Louis W
LW
Department of Health Policy and Management and Institute of Medical Technology Assessment, Erasmus MC, Erasmus University Rotterdam, Rotterdam, the Netherlands. l.niessen@erasmusmc.nl
Grijseels
Els
E
Koopmanschap
Marc
M
Rutten
Frans
F
D032921:Consensus; D003362:Cost-Benefit Analysis; D006287:Health Planning Guidelines; D006801:Humans; D009426:Netherlands; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000592:standards; D012189:Retrospective Studies