ACP develops framework for considering economic evidence in clinical guidelines

In recognition of accelerating health care spending and the impact on patients, ACP has developed a framework to standardize its approach to identifying, appraising, and considering economic evidence in the development of clinical guidelines. The framework, which aligns with ACP principles of promoting high-value care, is titled “Incorporating Economic Evidence in Clinical Guidelines: A Framework from the Clinical Guidelines Committee of the American College of Physicians” and was published Dec. 31, 2024, by Annals of Internal Medicine.

This framework presents and explains the process that ACP's Clinical Guidelines Committee utilizes for incorporating economic evidence into clinical recommendations. Eligible economic evidence includes cost-effectiveness analyses, economic outcomes in randomized controlled trials, and resource utilization (intervention cost) data. To develop a clinical recommendation, the committee first and foremost assesses the best available evidence for the clinical net benefit of interventions, weighing the benefits and harms. Patient values and preferences also play a major role in formulating the recommendations. After it has been determined that an intervention has clinical net benefit, economic evidence may be considered in prioritizing among recommended interventions of equal effectiveness or modifying the strength of recommendations. The committee's goal is to always inform clinicians about interventions' costs to enhance awareness about the burden on our patients and to support shared cost-conscious prescribing in real-life settings.

The framework was developed with the recognition that growing health care spending has not improved key health outcomes and that patients living in the U.S. experience a higher morbidity and lower life expectancy than those living in other high-income nations. Efforts to optimize spending should focus on the value of health care to ensure the best possible patient and public benefits in relation to costs and adverse effects from any intervention. ACP defines a high-value intervention as one whose clinical net benefit justifies its cost.

Economic evidence on an intervention is often limited, as health care spending estimates are dynamic and total costs of care are difficult to ascertain. However, ACP believes that price transparency is a necessary component to help patients understand and have access to the best clinical treatments that are also affordable.