PHILADELPHIA December 31, 2024 – The American College of Physicians (ACP), in recognition of accelerating health care spending and the impact on patients, has developed a framework that aligns with ACP principles of promoting high-value care, to standardize its approach to identifying, appraising, and considering economic evidence in the development of ACP clinical guidelines. Incorporating Economic Evidence in Clinical Guidelines: A Framework from the Clinical Guidelines Committee of the American College of Physicians was published today in Annals of Internal Medicine.
This framework presents and explains the process that ACP’s Clinical Guidelines Committee (CGC) 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. In addition, patient values and preferences play a major role in formulating the recommendations. After assessing if 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 intervention cost to enhance awareness about the burden on our patients and support shared cost-conscious prescribing in real-life settings.
The framework was developed in 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 compared with 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 each intervention. ACP in addition to the committee define a high-value intervention as one whose clinical net benefit justifies its cost.
“The cost of healthcare for patients is not sustainable and affordable. This framework is a critical component of clinical guideline development as it aims to provide guidance on recommendations that benefit the patient, while weighing cost as a factor that adds burden on our patients,” said Isaac O. Opole, president, ACP. “This will help physicians deliver the best care possible when considering high-value treatment options for patients.”
Economic evidence 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.
For example, when the committee judges that benefits outweigh harms for multiple interventions based on clinical evidence, it recommends each of those interventions as an option. Under the new framework, the CGC may consider economic evidence to prioritize among those interventions when there are important differences in cost.
ACP has been a global leader in the development of clinical guidelines and advancing science and methods. This framework represents a new advancement in guideline development that will continue to ensure that clinical recommendations consider factors important for physician, patient, public, and health system decision-making to deliver and receive high-value, sustainable health care.
“While the economic impact of a recommendation would not be the primary focus, as physicians consider the best clinically optimal benefit for the patients, cost can at least be a factor to consider the strength of the recommendation or prioritize among interventions with similar clinical net benefit,” added Dr. Opole.
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About the American College of Physicians
The American College of Physicians is the largest medical specialty organization in the United States with members in more than 172 countries worldwide. ACP membership includes 161,000 internal medicine physicians, related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on X, Facebook, Instagram and LinkedIn.
Contact: Andrew Hachadorian, 215 351 2514, ahachadorian@acponline.org