Many Guidelines Skirt Cost Issue

Frank Diamond

In an era when, some argue, much of medical management is being shifted toward the provider, a study shows that nearly half of physician professional societies still do not consider costs when developing guidelines.

This comes from a study, “Cost Consideration in the Clinical Guidance Documents of Physician Specialty Societies in the United States,” in the May 6 issue of JAMA Internal Medicine. It cites the Choosing Wisely initiative (which we’ve reported on /archives/2013/3/choosing-wisely-campaign-grows-wider-and-deeper) as a possible movement toward greater cost awareness among physician societies. It also reports on stiff resistance to that movement.

“Opponents of explicit cost consideration, however, believe that physicians should place individual patient needs ahead of societal needs, regardless of cost,” the study states. “Critics fear that the introduction of costs into clinical decision making at any level will ultimately lead to bedside rationing and cause a rift in the physician-patient relationship that will foster public mistrust of the medical community.”

The study’s authors looked at clinical guidelines for 30 specialty societies and found that 17 explicitly include cost in the discussion.

While nine of the societies use a system in which cost influences the strength of the recommendation, eight are “inconsistent in their approach or failed to mention the exact mechanism for considering costs.”

The authors offer the societies some advice. “In our analysis, the most common way to use cost in justifying a recommendation was to state that an intervention was recommended because it was as effective as other options but less costly.”

In an accompanying editorial, Joseph P. Drozda Jr., MD, sees hope that more attention will be paid to costs.

“It is safe to say that these societies will continue to address the appropriate use of medical interventions in their clinical guidance documents,” writes Drozda.

“It is probably also safe to say that the growing trend of formally addressing costs in guidance documents will continue as well.”

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