Objective:

To evaluate the incorporation of economic and resource use-related guidance in US clinical practice guidelines.

Approach:

• Study Design: Cross-sectional study analyzing 309 clinical practice guideline documents from 23 large US-based medical societies issued between 2019 and 2023.
• Data Collection: Guidelines were identified through the ECRI Guidelines Trust, and economic-related terms were used to assess recommendations.
• Analysis: The study assessed the presence of economic guidance in both upfront recommendation statements and narrative discussions.

Key Findings:

• Only 3.8% of recommendations included an upfront economic or resource use-related statement.
• 76% of guideline documents contained at least one recommendation with a narrative discussion of economic evidence.
• Recommendations from primary care societies were nearly 13 times more likely to include upfront economic statements compared to specialty societies.
• Across all 7,582 recommendations, 1,706, or 22.5%, included a narrative discussion of economic or resource use-related evidence.

Interpretation:

Despite an increase in attention to economic considerations in guideline development, they are infrequently included in individual recommendations.

Limitations:

• The assessment of economic guidance was based on a broad composite measure and did not evaluate the quality or clinical usefulness of the guidance.
• The sample was limited to guidelines in the ECRI Guidelines Trust and may not represent all guidelines from the included societies.

Conclusion:

Higher quality health economic evidence and explicit consideration of such evidence may improve the incorporation of economic guidance in clinical practice guidelines.

Sources:

• JAMA Network Open