A framework for incorporating cost-effectiveness in evidence-based clinical practice guidelines

In England, recent health care reforms emphasise the role of clinical guide lines in promoting effective and efficient health care. Introducing economi c data into guidelines raises some methodological issues: specifically, the provision of valid and generalisable cost estimates, the weight placed upo n cost 'evidence', and the presentation of cost-effectiveness information i n a manner accessible to clinicians. A series of primary care guidelines, e xplicitly including consideration of health economic information, have rece ntly been published, intended to help clinicians to aggregate the attribute s of treatment choices to derive treatment recommendations consistent with both the clinical decision-making process and social objectives. Clinicians involved in developing guidelines responded well to the process and consis tently managed to agree treatment recommendations, often after considerable debate about the evidence for treatment. In none of the guideline areas, a ll of which addressed common diseases, was there adequate information to es timate a cost per quality-adjusted-life-year, and it is unclear how helpful this approach would have been had it been possible. The implications of th is method are discussed, guidance offered for economists new to guideline d evelopment and future areas of work identified. (C) 1999 Elsevier Science I reland Ltd. All rights reserved.