Elsevier

JACC: Heart Failure

Volume 10, Issue 1, January 2022, Pages 1-11
JACC: Heart Failure

Clinical Research
Cost and Value in Contemporary Heart Failure Clinical Guidance Documents

https://doi.org/10.1016/j.jchf.2021.08.002Get rights and content
Under a Creative Commons license
open access

Abstract

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.

Key Words

appropriate use criteria
clinical practice guidelines
cost
expert consensus documents
heart failure
value-based medicine

Abbreviations and Acronyms

ACC
American College of Cardiology
ADA
American Diabetes Association
AHA
American Heart Association
CGD
clinical guidance document
CMR
cardiac magnetic resonance
HF
heart failure
TTE
transthoracic echocardiography

Cited by (0)

Barry Greenberg, MD, served as Guest Editor for this paper.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.