An Algorithm for Incorporating Economic Evidence Into Clinical Practice Guidelines: Application to the Spanish Guideline for the Management of Chronic Primary Pain

Abstract

The importance of incorporating economic evidence (EE) such as resource use, cost or cost-effectiveness evidence into Clinical Practice Guidelines (CPG) is being increasingly recognised by decision makers, including healthcare providers and policy makers. Yet, this is a complex and resource-intensive process. EE can influence recommendations formulated about interventions in CPGs, especially when the desirable and undesirable effects are balanced. A group of methodologists, including health economists, in GuíaSalud (the organisation of the Spanish National Health System (NHS) that coordinates the national CPG Programme), has made important advances in the development of methodological guidance for how to develop evidence-based recommendations. In this article, we present an algorithm for informing decisions about incorporating EE in CPGs. The algorithm has three stages: (1) prioritise clinical questions in the CPG according to the influence that EE is expected to have on recommendations; (2) obtain EE for clinical questions that have been prioritised via a systematic review and/or a de novo economic evaluation; and (3) use EE to inform recommendations in CPG. We show how the algorithm was applied in the development of GuíaSalud's CPG for the management of chronic primary pain. In doing so, we provide specific guidance on how the algorithm could be applied using concrete examples. We show how this algorithm helps to make the process of incorporating EE into CPGs agile, dynamic and reproducible.