Cost and value in liver disease guidelines: 2011-2022

Area of Science:

• Hepatology
• Health Economics
• Clinical Practice Guidelines

Background:

• Chronic liver disease (CLD) significantly increases healthcare utilization and costs.
• There is a growing emphasis on integrating cost and value (C/V) considerations into medical practice.
• Clinical guidance documents (CGDs) are crucial for shaping patient care and resource allocation.

Purpose of the Study:

• To determine the frequency of C/V statements within CLD-related CGDs.
• To assess the extent to which cost and value are incorporated into current liver disease clinical recommendations.

Main Methods:

• A systematic analysis of CLD-related CGDs published between January 2011 and February 2022.
• Included CGDs from three major US liver and gastroenterology societies: AASLD, ACG, and AGA.
• Quantified the proportion of C/V statements among all guidance statements.

Main Results:

• Forty-five CLD-related CGDs were analyzed.
• Only 6% (80 out of 1334) of guidance statements contained C/V information.
• A very small fraction (1.1%) reported patient-level costs, and none reported out-of-pocket costs.

Conclusions:

• The integration of C/V considerations into CLD clinical guidance is currently very limited.
• There is a significant opportunity to improve the incorporation of cost-effectiveness and value into liver disease management guidelines.
• Future guidelines should prioritize the inclusion of C/V data to support evidence-based, cost-conscious healthcare decisions.