Incorporating considerations of resources use into grading recommendations

doi:10.1136/bmj.39504.506319.80

BMJ 2008;336:1170-1173 (24 May), doi:10.1136/bmj.39504.506319.80

Analysis

Rating quality of evidence and strength of recommendations

Incorporating considerations of resources use into grading recommendations

Gordon H Guyatt, professor¹, Andrew D Oxman, researcher², Regina Kunz, associate professor³, Roman Jaeschke, clinical professor⁴, Mark Helfand, professor of medicine⁵, Alessandro Liberati, professor⁶, Gunn E Vist, researcher², Holger J Schünemann, associate professor⁷, for the GRADE working group

¹ Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada L8N 3Z5, ² Norwegian Knowledge Centre for the Health Services, PO Box 7004, 0130 Oslo, Norway, ³ Basel Institute of Clinical Epidemiology, University Hospital Basel, 4031 Basel, Switzerland, ⁴ Department of Medicine, McMaster University, Hamilton, ON, Canada L8N 3Z5, ⁵ Portland VA Medical Center and OHSU Department of Medicine, Portland, Oregon 97201, ⁶ Università di Modena e Reggio Emilia and Agenzia Sanitaria Regionale, Regione Emilia Romagna, 40127 Bologna, Italy, ⁷ Department of Epidemiology, Italian National Cancer Institute Regina Elena, Rome, Italy

Correspondence to: G H Guyatt guyatt@mcmaster.ca

Guideline panellists have differing opinions on whether resourceuse should influence decisions on individual patients. As medicalcare costs rise, resource use considerations become more compelling,but panellists may find dealing with such considerations challenging

The first 150 words of the full text of this article appear below.

In this last part of a series describing the GRADE (Gradingof Recommendations Assessment, Development and Evaluation) approachto making recommendations we will look at how guideline panellistsand clinicians can incorporate matters related to the use ofresources into recommendations and practice. Clinical recommendationsinevitably involve judgments about the allocation of resources,judgments commonly referred to as costs. We will deal with someof the challenges of considering costs, explain reasons forfocusing on resource use rather than costs, and discuss howto incorporate considerations of resource use into recommendations.

In one sense, cost is just another potentially important outcome—likemortality, morbidity, and quality of life—associated withalternative ways of managing patients. In addition to theseclinical outcomes, an intervention may increase costs or decreasecosts. However, costs differ from other outcomes in severalways (box).¹

Patientsreceive health benefits and bear the burden of adverse healthoutcomes, but . . . [Full text of this article]

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

StumbleUpon Add to Technorati

Technorati What's this?

Relevant Articles

What should clinicians do when faced with conflicting recommendations?: Andrew D Oxman, Paul Glasziou, and John W Williams, Jr
BMJ 2008 337: a2530. [Extract] [Full Text]

Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive: Roman Jaeschke, Gordon H Guyatt, Phil Dellinger, Holger Schünemann, Mitchell M Levy, Regina Kunz, Susan Norris, Julian Bion for the GRADE working group
BMJ 2008 337: a744. [Extract] [Full Text]

Users' guide to detecting misleading claims in clinical research reports: Victor M Montori, Roman Jaeschke, Holger J Schünemann, Mohit Bhandari, Jan L Brozek, P J Devereaux, and Gordon H Guyatt
BMJ 2004 329: 1093-1096. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

Guyatt, G. H., Helfand, M., Kunz, R. (2009). Comparing the USPSTF and GRADE Approaches to Recommendations. ANN INTERN MED 151: 363-363 [Full text]
Petitti, D. B., Teutsch, S. M., Barton, M. B., Sawaya, G. F., Ockene, J. K., DeWitt, T. (2009). Comparing the USPSTF and GRADE Approaches to Recommendations. ANN INTERN MED 151: 363-364 [Full text]
Hahn, D. L. (2009). Importance of Evidence Grading for Guideline Implementation: The Example of Asthma. Ann Fam Med 7: 364-369 [Abstract] [Full text]
Oxman, A. D, Glasziou, P., Williams, J. W Jr (2008). What should clinicians do when faced with conflicting recommendations?. BMJ 337: a2530-a2530 [Full text]
Tobin, M. J. (2008). Response. Chest 134: 1108-1108 [Full text]
Soares, M., Dumville, J. C (2008). Critical appraisal of cost-effectiveness and cost-utility studies in health care. Evid. Based Nurs. 11: 99-102 [Full text]
Jaeschke, R., Guyatt, G. H, Dellinger, P., Schunemann, H., Levy, M. M, Kunz, R., Norris, S., Bion, J., for the GRADE working group, (2008). Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive. BMJ 337: a744-a744 [Full text]