Professional medical societies don't often consider costs
when they're developing their treatment guidelines for specific conditions,
according to a new study.
Researchers found that just over half of the top medical
societies with at least 10 000 members considered costs when developing best
practices. The other half either implicitly considered costs or didn't address
them at all.
"Even when they said they looked at costs, they didn't
seem to have a clear, consistent or rigorous way to do so," said Dr Steven
Pearson, the study's senior author and a visiting scientist in the Department
of Bioethics at the National Institutes of Health in Bethesda, Maryland.
Pearson and his colleague Dr Jennifer Schwartz write in JAMA
Internal Medicine that while a lot of debate has focused on the cost of
healthcare in the US; few researchers have looked at whether professional
societies develop their treatment recommendations with costs in mind.
Clinical guidelines are often crafted by professional
medical societies to help doctors decide which therapies are best for certain
conditions. But saying a treatment is not worth the cost may spark fears of
care rationing."It's obviously very controversial about when costs should
be included in the discussion of healthcare," Pearson said.
But the professional practice recommendations may factor
into reimbursement policies among organisations that pay for treatment, like
the Centers for Medicare and Medicaid Services. For the new study, the
researchers examined the publicly available clinical guidelines issued by the
30 largest US medical societies between 2008 and 2012 to see which ones
More than half - 17 of the 30 societies - explicitly
included costs in their discussion of clinical guidelines, four at least
implicitly considered costs, three purposely excluded costs and six did not
mention prices. The researchers then examined the 279 guidelines published by
the 17 societies that included costs in their decisions.
Costs involved in evaluation
Based on that review, they found nine had a formal evaluation
system for costs. The other eight societies had several methods to evaluate
costs or didn't mention their process."I think it's encouraging the
societies are now starting to include costs into their guidelines. And when
they decide not to, I think it's important to be transparent about that,"
said Schwartz, a research fellow in the NIH Department of Bioethics.
Dr Joseph Drozda, from the Center for Innovative Care at
Mercy in Chesterfield, Missouri, said he believes more and more societies will
be including cost analyses in their guidelines."(The researchers) caught
it on the upslope so I think we're going to see more attention to cost in
guidelines," said Drozda, the chair of the American College of Cardiology
Foundation's Clinical Quality Committee who wrote a commentary accompanying the
"I think clearly there is - over time - more of an
interest in incorporating cost issues into guidelines," said Dr Steven
Weinberger, executive vice president and CEO of the American College of
Physicians in Philadelphia."What a lot of organisations are doing - and
certainly what we're doing - is recognising that there are so many areas of
overuse and misuse of care," said Weinberger, who has written about
cost-conscious care but was not involved in the new research.
He added that the
discussion of costs in healthcare is not about rationing, but finding which
treatments offer the best value."I would really like to see a much more
open dialogue between physicians and patients about costs," Weinberger