Economic analysis for clinical practice - The case of 31 national consensus guidelines in the Netherlands

Louis Niessen, Els Grijseels, Marc Koopmanschap, Frans Rutten

Research output: Contribution to journalArticle

Abstract

Rationale, aims and objective: Evidence on the cost-effectiveness of health interventions in the development of practice guidelines has become of interest in many countries. Challenges are the quality of economic data, the use of cost-effectiveness criteria, and the consensus process. Our paper aims to assess the quality and use of economic information in the formulation of consensus guidelines in a Dutch pilot programme and to recommend improvements. Methods: Retrospective qualitative review of economic evaluations and formulated recommendations, using a checklist based on international standards. Results: The national programme to support the development of guidelines with economic analysis in multidisciplinary consensus groups run from 1998 to 2002. It has included 31 medical guidelines, addressing 23 conditions across seven International Classification of Diseases (ICD)-disease groups. Experts in health technology assessment have participated in the guidelines groups. Economic information in all guidelines varies by all criteria in the level of evidence used. Information on quality-adjusted life years gained is limited as is statistical analysis in most studies. Highest cost-effectiveness ratios reported are between €20 000 and €30 000. However, there is no uniformity in the definitions of acceptable cost-effectiveness ratios. Conclusions: Economic recommendations can be included in guidelines. Interaction between clinicians and health economists promotes a balance between medical and economic arguments. Among panellists there appears to be agreement on the level of the cost-effectiveness ratios that is acceptable. It is recommended that economic analysis is used to strengthen the evidence-base of guidelines. An evidence-grading system should include the quality of economic evaluation. Roles of policymakers and providers need to be defined.

Original languageEnglish (US)
Pages (from-to)68-78
Number of pages11
JournalJournal of Evaluation in Clinical Practice
Volume13
Issue number1
DOIs
StatePublished - Feb 2007
Externally publishedYes

Fingerprint

Netherlands
Cost-Benefit Analysis
Economics
Guidelines
Medical Economics
Biomedical Technology Assessment
Quality-Adjusted Life Years
Health
International Classification of Diseases
Checklist
Practice Guidelines

Keywords

  • Cost-effectiveness analysis
  • Economic evaluation
  • Practical guidelines
  • The Netherlands

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health Information Management
  • Nursing(all)

Cite this

Economic analysis for clinical practice - The case of 31 national consensus guidelines in the Netherlands. / Niessen, Louis; Grijseels, Els; Koopmanschap, Marc; Rutten, Frans.

In: Journal of Evaluation in Clinical Practice, Vol. 13, No. 1, 02.2007, p. 68-78.

Research output: Contribution to journalArticle

@article{47e865f8bfba40ff8fc154412299713c,
title = "Economic analysis for clinical practice - The case of 31 national consensus guidelines in the Netherlands",
abstract = "Rationale, aims and objective: Evidence on the cost-effectiveness of health interventions in the development of practice guidelines has become of interest in many countries. Challenges are the quality of economic data, the use of cost-effectiveness criteria, and the consensus process. Our paper aims to assess the quality and use of economic information in the formulation of consensus guidelines in a Dutch pilot programme and to recommend improvements. Methods: Retrospective qualitative review of economic evaluations and formulated recommendations, using a checklist based on international standards. Results: The national programme to support the development of guidelines with economic analysis in multidisciplinary consensus groups run from 1998 to 2002. It has included 31 medical guidelines, addressing 23 conditions across seven International Classification of Diseases (ICD)-disease groups. Experts in health technology assessment have participated in the guidelines groups. Economic information in all guidelines varies by all criteria in the level of evidence used. Information on quality-adjusted life years gained is limited as is statistical analysis in most studies. Highest cost-effectiveness ratios reported are between €20 000 and €30 000. However, there is no uniformity in the definitions of acceptable cost-effectiveness ratios. Conclusions: Economic recommendations can be included in guidelines. Interaction between clinicians and health economists promotes a balance between medical and economic arguments. Among panellists there appears to be agreement on the level of the cost-effectiveness ratios that is acceptable. It is recommended that economic analysis is used to strengthen the evidence-base of guidelines. An evidence-grading system should include the quality of economic evaluation. Roles of policymakers and providers need to be defined.",
keywords = "Cost-effectiveness analysis, Economic evaluation, Practical guidelines, The Netherlands",
author = "Louis Niessen and Els Grijseels and Marc Koopmanschap and Frans Rutten",
year = "2007",
month = "2",
doi = "10.1111/j.1365-2753.2006.00662.x",
language = "English (US)",
volume = "13",
pages = "68--78",
journal = "Journal of Evaluation in Clinical Practice",
issn = "1356-1294",
publisher = "Wiley-Blackwell",
number = "1",

}

TY - JOUR

T1 - Economic analysis for clinical practice - The case of 31 national consensus guidelines in the Netherlands

AU - Niessen, Louis

AU - Grijseels, Els

AU - Koopmanschap, Marc

AU - Rutten, Frans

PY - 2007/2

Y1 - 2007/2

N2 - Rationale, aims and objective: Evidence on the cost-effectiveness of health interventions in the development of practice guidelines has become of interest in many countries. Challenges are the quality of economic data, the use of cost-effectiveness criteria, and the consensus process. Our paper aims to assess the quality and use of economic information in the formulation of consensus guidelines in a Dutch pilot programme and to recommend improvements. Methods: Retrospective qualitative review of economic evaluations and formulated recommendations, using a checklist based on international standards. Results: The national programme to support the development of guidelines with economic analysis in multidisciplinary consensus groups run from 1998 to 2002. It has included 31 medical guidelines, addressing 23 conditions across seven International Classification of Diseases (ICD)-disease groups. Experts in health technology assessment have participated in the guidelines groups. Economic information in all guidelines varies by all criteria in the level of evidence used. Information on quality-adjusted life years gained is limited as is statistical analysis in most studies. Highest cost-effectiveness ratios reported are between €20 000 and €30 000. However, there is no uniformity in the definitions of acceptable cost-effectiveness ratios. Conclusions: Economic recommendations can be included in guidelines. Interaction between clinicians and health economists promotes a balance between medical and economic arguments. Among panellists there appears to be agreement on the level of the cost-effectiveness ratios that is acceptable. It is recommended that economic analysis is used to strengthen the evidence-base of guidelines. An evidence-grading system should include the quality of economic evaluation. Roles of policymakers and providers need to be defined.

AB - Rationale, aims and objective: Evidence on the cost-effectiveness of health interventions in the development of practice guidelines has become of interest in many countries. Challenges are the quality of economic data, the use of cost-effectiveness criteria, and the consensus process. Our paper aims to assess the quality and use of economic information in the formulation of consensus guidelines in a Dutch pilot programme and to recommend improvements. Methods: Retrospective qualitative review of economic evaluations and formulated recommendations, using a checklist based on international standards. Results: The national programme to support the development of guidelines with economic analysis in multidisciplinary consensus groups run from 1998 to 2002. It has included 31 medical guidelines, addressing 23 conditions across seven International Classification of Diseases (ICD)-disease groups. Experts in health technology assessment have participated in the guidelines groups. Economic information in all guidelines varies by all criteria in the level of evidence used. Information on quality-adjusted life years gained is limited as is statistical analysis in most studies. Highest cost-effectiveness ratios reported are between €20 000 and €30 000. However, there is no uniformity in the definitions of acceptable cost-effectiveness ratios. Conclusions: Economic recommendations can be included in guidelines. Interaction between clinicians and health economists promotes a balance between medical and economic arguments. Among panellists there appears to be agreement on the level of the cost-effectiveness ratios that is acceptable. It is recommended that economic analysis is used to strengthen the evidence-base of guidelines. An evidence-grading system should include the quality of economic evaluation. Roles of policymakers and providers need to be defined.

KW - Cost-effectiveness analysis

KW - Economic evaluation

KW - Practical guidelines

KW - The Netherlands

UR - http://www.scopus.com/inward/record.url?scp=33846919654&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33846919654&partnerID=8YFLogxK

U2 - 10.1111/j.1365-2753.2006.00662.x

DO - 10.1111/j.1365-2753.2006.00662.x

M3 - Article

C2 - 17286726

AN - SCOPUS:33846919654

VL - 13

SP - 68

EP - 78

JO - Journal of Evaluation in Clinical Practice

JF - Journal of Evaluation in Clinical Practice

SN - 1356-1294

IS - 1

ER -