Heading to economic-based clinical guidelines

In the 1980s clinical guidelines made their entrance in the Dutch health care arena. Several years later, in 1997, the Minister of Health proposed the incorporation of cost-effectiveness information in clinical guidelines. The reasoning behind incorporating economic considerations in clinical guidelines is it will result in treatment choices that are both consistent with clinical as well as social objectives. This study aims to provide insight in the current position of economic considerations during clinical guideline development and tries to answer the question why economic evidence is (not) included in clinical guidelines. To get a well-informed picture, recommendations concerning (pharmaco therapeutic) interventions in the depression, Parkinson’s disease and stroke guidelines were scored on the AGREE-plus efficiency questions. After the AGREE-plus efficiency scores were gathered, semi-structured interviews with clinical guideline developers were conducted. With these interviews information was gathered regarding the reasoning behind (not) including economic considerations during clinical guideline development. The scores on the AGREE-plus efficiency questions illustrate that only limited attention is paid to economic evidence in the recommendation concerning (pharmaco therapeutic) interventions in the clinical guidelines under study. The high costs for consulting a health economist, the limited availability of high quality economic evaluations, the lack of a uniform applied development procedure and the absence of a well-defined decision-making framework were brought forward as arguments. Alongside these arguments the political arena was argued to play a key role in the journey towards economic-based guidelines. However, next to the vital role of the government, a joint deployment of all stakeholders is thought to be needed to take necessary steps toward economic-based guidelines. Effort should be put in convincing all stakeholders that economic-based guidelines, in addition to other efficiency improving measures, could lead to a more efficient and cost conscious health care system.