Incorporating Considerations of Cost-Effectiveness, Affordability, and Resource Implications in Guideline Development

Abstract

Many authorities suggest that there is a need to include explicit consideration of costs, resource use, and affordability during guideline development. Where drug use is at issue, "explicit consideration" may need to involve only noting whether the price (easily determined and usually the main component of "acquisition cost") of a drug is high or low. Complex interventions such as rehabilitation services are to a greater degree setting- and system-dependent. Resources used, and the costs of those resources, will vary among systems, and formal identification by a guideline group of the resource requirements of a complex intervention is essential. A clinical guideline usually contains multiple recommendations, and in some cases there are hundreds. Defining costs and resource use for all of them-especially for multiple settings-is unlikely to be feasible. At present, disaggregated resource utilization accompanied by some cost information seems to be the most promising approach. The method for assigning values to costs, including external or indirect cost (such as time off work), can have a significant impact on the outcome of any economic evaluation. The perspective that the guideline assumes should be made explicit. Standards for evidence for clinical data are usually good-quality trials reporting a relevant endpoint that should be summarized in a systematic review. Like others, we are therefore proposing that the ideal sources of evidence for cost and resource utilization data for guideline development are systematic reviews of randomized controlled trials that report resource utilization, with direct comparisons between the interventions of interest.

Systematic overview of economic evaluations of health-related rehabilitation

“…(2) what would be the cost benefits of different rehabilitation outcomes for the individual, family and society? Findings from the overview may shed light on the two questions.…”

“…For the purpose of guideline development, cost-effectiveness or cost-benefit ratios are generally considered less informative, compared to disaggregated data on costs and resource utilization for an intervention. 2,91 It has been recommended that SRs should focus on the identification of key variables that may be used to estimate the cost and affordability of relevant interventions in different settings. 2,91 Limitations Some relevant SRs may have not been included in the overview.…”

“…2,91 It has been recommended that SRs should focus on the identification of key variables that may be used to estimate the cost and affordability of relevant interventions in different settings. 2,91 Limitations Some relevant SRs may have not been included in the overview. Because of the restriction of time and other resources, we only included SRs published in English, and the literature search may not be sufficient sensitive to identify some SRs that did not describe the intervention as a health-related rehabilitation.…”

Health economic evidence in clinical guidelines in South Africa: a mixed-methods study

“…Internationally, published literature and governmental publications indicate the need for more rigorous methods and processes to ensure CPG recommendations are informed by the best available evidence, including cost-effectiveness, resource use and equity [ 4 – 6 ]. It also shows that the utilisation of HEE in the production of CPGs by health authorities is already ongoing to varying degrees [ 4 , 7 – 9 ]. For example, HEE is taken into account when making medicine reimbursement decisions globally, including in South Africa [ 10 ], and in some cases these decisions are reflected in related CPGs.…”

A Guide to Guidelines for Pulmonary, Sleep, and Critical Care Medicine Clinicians

“…For information sources about costs, the workshop panel favors randomized trials that report resource consumption over formal models of cost-effectiveness, but each of these approaches has advantages and disadvantages (13).…”