Editor—Wailoo et al are confused about the issues of incorporating economic considerations in clinical guidelines.1 Several publications directly and usefully address the issues of incorporating economic perspectives into guidelines.2-5
The primary purpose of clinical guidelines is to inform clinicians' decisions with regard to patients, with a wider readership of interested parties, such as managers. Such guidance is not mandatory.
Wailoo et al argue that only health economists promote the social viewpoint within guideline development groups. We have shown that appropriately multidisciplinary groups of clinicians and consumers, supported by a health economist, are capable of adopting a social perspective on health care.5 Although health economists may offer methods, they do not have an exclusive claim to the social perspective.
Wailoo et al propose removing health economic input into a separate process conducted away from the discussion of the meaning of the clinical evidence. They do not recognise two separate types of analysis. The incorporation of economic considerations into a guideline (the balancing of effectiveness, side effects, other harms, and financial cost in choosing strategies to lower blood pressure) must all be debated within the same forum. The cost impact of a guideline may be considered within or outside this forum. Both analyses will be plagued by inadequate data. The purpose of Wailoo et al in setting up a separate forum seems to be to produce a ranked cost utility list, presumably both within and across guidelines. This idea was recognised as unrealistic long before David Eddy articulated its impossibility in 1999.4
If health economics is to contribute to this debate it must engage with the complexity of the issues rather than propose one size fits all solutions.
Competing interests: ME is a consultant on guideline methodology to and was chair of the Guideline Advisory Committee, 1999-2003, for the National Institute for Clinical Excellence.
References
- 1.Wailoo A, Roberts J, Brazier J, McCabe C. Efficiency, equity, and NICE clinical guidelines. BMJ 2004;328: 536-7. (6 March.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Eddy DM. A manual for assessing health practices and designing practice policies: the explicit approach. Philadelphia: American College of Physicians, 1992.
- 3.Williams A. How should information on cost effectiveness influence clinical practice? In: Delamothe T, ed. Outcomes into clinical practice. London: BMJ Publishing Group, 1995: 99-107.
- 4.Eddy DM. Doctors, economics and clinical practice guidelines: can they be brought together? London: Office of Health Economics, 1999.
- 5.Eccles M, Mason J. How to develop cost-conscious guidelines. Health Technol Assess 2001;5(16). [DOI] [PubMed]