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The limited incorporation of economic analyses in clinical practice guidelines

  • Health Policy
  • Published:
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Abstract

BACKGROUND: Because there is increasing concern that economic data are not used in the clinical guideline development process, our objective was to evaluate the extent to which economic analyses are incorporated in guideline development.

METHODS: We searched medline and HealthSTAR databases to identify English-language clinical practice guidelines (1996–1999) and economic analyses (1990–1998). Additional guidelines were obtained from The National Guidelines Clearinghouse Internet site available at http://www.guideline.gov. Eligible guidelines met the Institute of Medicine definition and addressed a topic included in an economic analysis. Eligible economic analyses assessed interventions addressed in a guideline and predated the guideline by 1 or more years. Economic analyses were defined as incorporated in guideline development if 1) the economic analysis or the results were mentioned in the text or 2) listed as a reference. The quality of economic analyses was assessed using a structured scoring system.

RESULTS: Using guidelines as the unit of analysis, 9 of 35 (26%) incorporated at least 1 economic analysis of above-average quality in the text and 11 of 35 (31%) incorporated at least 1 in the references. Using economic analyses as the unit of analysis, 63 economic analyses of above-average quality had opportunities for incorporation in 198 instances across the 35 guidelines. Economic analyses were incorporated in the text in 13 of 198 instances (7%) and in the references in 18 of 198 instances (9%).

CONCLUSIONS: Rigorous economic analyses may be infrequently incorporated in the development of clinical practice guidelines. A systematic approach to guideline development should be used to ensure the consideration of economic analyses so that recommendations from guidelines may impact both the quality of care and the efficient allocation of resources.

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Authors and Affiliations

  1. Zynx Health Incorporated, a Subsidiary of Cedars-Sinai Health System, USA

    Joel F. Wallace PharmD, MPH, MBA, Scott R. Weingarten MD, MPH, Chiun-Fang Chiou PhD, Andriana A. Hohlbauch MPH, Lior S. Lewensztain &  Joshua J. Ofman MD, MSHS

  2. Cedars-Sinai Departments of Medicine and Health Services Research, Los Angeles, Calif

    Scott R. Weingarten MD, MPH, Nicole S. Herzog MD &  Joshua J. Ofman MD, MSHS

  3. TAP Pharmaceutical Products Inc., Lake Forest, Ill

    James M. Henning MS & Margaret S. Richards PhD

Authors
  1. Joel F. Wallace PharmD, MPH, MBA
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  2. Scott R. Weingarten MD, MPH
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  3. Chiun-Fang Chiou PhD
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  8. Lior S. Lewensztain
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  9. Joshua J. Ofman MD, MSHS
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Correspondence to Joshua J. Ofman MD, MSHS.

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This investigator-initiated work was supported by a research grant from TAP Pharmaceutical Products, Inc.

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Wallace, J.F., Weingarten, S.R., Chiou, CF. et al. The limited incorporation of economic analyses in clinical practice guidelines. J GEN INTERN MED 17, 210–220 (2002). https://doi.org/10.1046/j.1525-1497.2002.10522.x

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