Clinical practice guidelines lack value-conscious considerations

Most medical societies urge their clinical-guidance developers to include cost data alongside care recommendations. Yet less than a quarter of published advisements—22.5%—contain evidence-based discussions on economic considerations or resource consumption. 

The findings are from a study conducted at Yale and published in JAMA Network Open June 26. 

Lead author Anand Habib, MD, MPhil, MHS, senior author Joseph Ross, MD, MHS, and colleagues further found a mere 3.8% of medical-society guidelines had upfront economic or resource use–related recommendation statements.

For the research, the team analyzed manuals instructing guidance developers at 23 large, U.S.-based medical societies. 

Per the 23 societies’ guidance-development manuals, some 14 societies (60.9%) explicitly suggested that economic or resource use–related evidence be considered. 

Yet only 1,706 of 7,582 resulting recommendations—the 22.5% noted above—included cost-conscious considerations. 

Meanwhile six of 23 development manuals (26.1%) “ambiguously addressed” the approach, and three (13.0%) never addressed it at all.

Value is where the actions make good on the words  

In their discussion section, Habib and co-authors note U.S. healthcare’s ongoing call for keeping the value in “value-based” care. 

They underscore two points from their primary findings:  

• Recommendations issued by societies that, according to their CPG methods manuals, explicitly suggested that economic or resource use–related evidence be considered had 6-fold greater odds of discussing such evidence but did not demonstrate greater odds of providing upfront economic or resource use–related statements. 
   
• By contrast, although primary care societies’ recommendations did not have greater odds of discussing economic or resource use–related evidence, they had nearly 13-fold higher odds of providing upfront economic or resource use–related recommendation statements.

A clear path forward emerges 

“With $100 billion in healthcare expenditures arising from low-value care and 4 of 5 physicians eager to follow value-based care recommendations within clinical practice guidelines, societies may be increasingly recognizing the relevance of economic or resource use–related considerations,” the authors remark. 

With higher quality health-economic evidence and societies clarifying how they appraise such evidence, they add, medical societies’ clinical practice guidelines “could better inform value-based care amidst rising healthcare costs.”

The study is posted in full for free.