gms | German Medical Science

Background: Good practice suggests that, when developing Clinical Guidelines, cost effectiveness (CE) evidence should be considered for each Clinical Review Question (CRQ) where practically possible. The form of CE evidence considered may include de novo cost-utility models and/or the qualitative judgement guidance-producing committees with or without costing analysis and/or consideration of published economic evidence.

Objectives: To identify attributes that predict reliance on qualitative judgement alone when considering CE in CRQs.

Methods: We evaluated all Clinical Guidelines produced for England and Wales since 2009 to identify factors influencing the economic evidence considered in formulating recommendations. We present a descriptive analysis. We conducted logistic regression to explore a range of potential predictors including: question type (prognostic, diagnostic, intervention, etc); inclusion of branded pharmaceuticals; and existence of previous related health technology assessments.

Results: A preliminary analysis of one guideline development team’s outputs suggests that the odds of recommendations being made on the basis of qualitative judgement alone are significantly lower for CRQs relating to interventions (OR=0.158 [95%CI: 0.037, 0.679]; p=0.013) compared with other types of question. Multivariate analysis of the full dataset including other variables will be presented.

Discussion: Committee members may be required to apply CE principles to CRQs on the basis of qualitative judgement alone. It is possible to identify factors within CRQs that will influence the form of CE considered.

Implications for Guideline Developers: Understanding the factors that lead to committees relying on qualitative judgement of CE considerations may assist planning for health-economic resources required by guidance-producing committees.