Allergy and Immunology Guidelines Lack Cost Considerations

Recent research presented at the 2017 AAAAI Annual Meeting revealed that while the majority of specialty guidelines contain recommendations that take costs into account, no standard methodology exists for approaching cost concerns during guideline development.  

“Many physician specialty societies are addressing cost in their clinical guidelines as health care costs rise,” Akilah A Jefferson, MD, MSc, of the department of bioethics at the National Institutes of Health Clinical Center, said in a presentation. “Our aim is to describe how cost is addressed within allergy and immunology guidelines during the height of health care reform in the United States.”

In order to identify practice parameters published between 2010 and 2015, Dr Jefferson and colleagues searched research indexes including PubMed, the National Guideline Clearinghouse, the AAAAI website, the American College of Allergy, Asthma and Immunology website, and the Joint Task Force website. They identified how many practice guidelines explicitly considered costs during their development and how many considered costs to justify specific recommendations.

Study results showed that of the 22 practice guidelines identified, none of them explicitly integrated costs during the development phase. The researchers found that 82% of guidelines had information on costs, while 18% explicitly did not consider costs during development.

Additionally, they found that 64% of guidelines had at least one recommendation that considered costs in its methodology—while, 36% did not include such language. 

“While none of the practice parameters explicitly considered cost in guideline methodology, almost two thirds considered cost to justify specific recommendations,” Dr Jefferson noted. “This suggests that cost is important to the specialty, but a standard way of approaching cost has not been well developed and adopted.”

Dr Jefferson and colleagues proposed adoption of a GRADE rating system in order to determine which guidelines contain explicit cost considerations. —David Costill