Concerns for the cost implications of clinical decision-making by providers and health plans have increased significantly in the recent past, as well as the advice to consider cost in addition to efficacy as a part of the treatment paradigm. However, little research has been conducted to evaluate whether this concern has been reflected in the development of official clinical guidance issued by various medical groups and societies. A new study has reviewed the role of costs in clinical guidance statements issued by 30 of the largest specialty societies in the United States between 2008 and 2012 (Schwartz JA, et al. JAMA Intern Med. 2013 May 6. [Epub ahead of print]).
The investigators focused on 3 specific questions, including (1) whether costs are being included as part of the considerations in the development of a clinical guidance by any of these 30 societies, (2) the mechanism or methodology by which any cost considerations are incorporated into the recommendations, and (3) the manner that cost issues are being used to support the clinical practice recommendations.
Of the 30 specialty physician societies included in this study, only 17 (57%) organizations explicitly consider cost issues in their guidance recommendations; 4 (13%) implicitly relate to costs in their methodological statements; 3 (10%) intentionally do not include costs as part of their rationale for their recommendations; and 6 (20%) do not make any reference to cost in any way that suggests whether the lack of consideration of cost is done intentionally.
Among the 17 societies that do consider cost in their clinical guidance explicitly, 9 (53%) incorporate a system to explain the strength of the impact of cost on the recommendation, and 8 (47%) societies use an inconsistent approach or have not mentioned the mechanism by which costs were influencing their recommendations.
Of the 138 specific recommendations included in these guidance documents that included cost as a component of their guidance rationale, the most frequent (36%) recommendation advocates the use of a specific treatment or a medical device as a result of a similar effectiveness among different options and lower costs associated with that specific device or treatment.
Although slightly more than 50% do consider cost issues in their guidance development and half of them explain the impact of cost on the strength of the recommendation, many specialty societies still do not include any cost considerations in their clinical guidance or are vague and nonspecific about it having any true clinical value. The investigators suggest that “physician specialty societies should demonstrate greater transparency and rigor in their approach to cost considerations in documents meant to influence care decisions."
