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Cost and Value in Contemporary Heart Failure Clinical Guidance Documents
JACC: Heart Failure ( IF 13.0 ) Pub Date : 2021-11-10 , DOI: 10.1016/j.jchf.2021.08.002
John W Ostrominski 1 , Sameer Hirji 2 , Ankeet S Bhatt 1 , Javed Butler 3 , Mona Fiuzat 4 , Gregg C Fonarow 5 , Paul A Heidenreich 6 , James L Januzzi 7 , Carolyn S P Lam 8 , Thomas M Maddox 9 , Christopher M O'Connor 10 , Muthiah Vaduganathan 1
Affiliation  

Objectives

This study sought to evaluate the frequency and nature of cost/value statements in contemporary heart failure (HF) clinical guidance documents (CGDs).

Background

In an era of rising health care costs and expanding therapeutic options, there is an increasing need for formal consideration of cost and value in the development of HF CGDs.

Methods

HF CGDs published by major professional cardiovascular organizations between January 2010 and February 2021 were reviewed for the inclusion of cost/value statements.

Results

Overall, 33 documents were identified, including 5 (15%) appropriate use criteria, 7 (21%) clinical practice guidelines, and 21 (64%) expert consensus documents. Most CGDs (27 of 33; 82%) included at least 1 cost/value statement, and 20 (61%) CGDs included at least 1 cost/value-related citation. Most of these statements were found in expert consensus documents (77.7%). Three (9%) documents reported estimated costs of recommended interventions, but only 1 estimated out-of-pocket cost. Of 179 cost/value-related statements observed, 116 (64.8%) highlighted the economic impact of HF or HF-related care, 6 (3.4%) advocated for cost/value issues, 15 (8.4%) reported gaps in cost/value evidence, and 42 (23.5%) supported clinical guidance recommendations. Over time, patterns of inclusion of statements and citations of cost/value have been largely stable.

Conclusions

Although most contemporary HF CGDs contain at least 1 cost/value statement, most CGDs focus on the high economic impact of HF and its related care; explicit inclusion of cost/value to support clinical guidance recommendations remains infrequent. These results highlight key opportunities for the integration of formalized cost/value considerations in future HF-focused CGDs.



中文翻译:

当代心力衰竭临床指导文件的成本和价值

目标

本研究旨在评估当代心力衰竭 (HF) 临床指导文件 (CGD) 中成本/价值陈述的频率和性质。

背景

在医疗保健成本不断上涨和治疗选择不断扩大的时代,越来越需要在开发 HF CGD 时正式考虑成本和价值。

方法

审查了主要专业心血管组织在 2010 年 1 月至 2021 年 2 月期间发布的 HF CGD,以纳入成本/价值陈述。

结果

总共确定了 33 份文件,包括 5 份 (15%) 适当使用标准、7 份 (21%) 临床实践指南和 21 份 (64%) 专家共识文件。大多数 CGD(33 个中的 27 个;82%)包括至少 1 个成本/价值声明,20 个(61%)CGD 包括至少 1 个成本/价值相关引用。这些陈述中的大多数都可以在专家共识文件中找到(77.7%)。三份(9%)文件报告了推荐干预措施的估计费用,但只有一份估计的自付费用。在观察到的 179 个成本/价值相关声明中,116 个(64.8%)强调了 HF 或 HF 相关护理的经济影响,6 个(3.4%)主张成本/价值问题,15 个(8.4%)报告了成本/价值方面的差距证据,42 项(23.5%)支持临床指导建议。随着时间的推移,成本/价值的陈述和引用模式基本稳定。

结论

尽管大多数当代 HF CGD 至少包含 1 个成本/价值声明,但大多数 CGD 关注的是 HF 及其相关护理的高经济影响;明确包含成本/价值以支持临床指导建议的情况仍然很少见。这些结果突出了在未来以 HF 为重点的 CGD 中整合正式成本/价值考虑的关键机会。

更新日期:2021-12-28
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