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Addressing Resource Allocation Issues in Recommendations From Clinical Practice Guideline Panels*: Suggestions From an American College of Chest Physicians Task Force

Gordon Guyatt, MD, MSc, FCCP; Michael Baumann, MD, MSc, FCCP; Stephen Pauker, MD; Jonathan Halperin, MD; Janet Maurer, MD, MBA, FCCP; Douglas K. Owens, MD; Anna N.A. Tosteson, ScD; Brian Carlin, MD, FCCP; David Gutterman, MD, FCCP; Martin Prins, MD; Sandra Zelman Lewis, PhD; Holger Schünemann, MD, PhD, FCCP
Author and Funding Information

*From the Department of Medicine (Dr. Guyatt), McMaster University, Hamilton, ON, Canada; the University of Mississippi Medical Center (Dr. Baumann), Jackson MS; Tufts-New England Medical Center (Dr. Pauker), Boston, MA; Mount Sinai Medical Center (Dr. Halperin), New York, NY; the Department of Veterans Affairs (Dr. Owens), Palo Alto Health Care System, Palo Alto, CA; the Departments of Medicine (Dr. Tosteson), Dartmouth Medical School, Hanover, NH; Drexel University School of Medicine (Dr. Carlin), Philadelphia, PA; the Department of Medicine (Dr. Gutterman), Medical College of Wisconsin, Milwaukee, WI; the Health and Science Policy Committee (Dr. Lewis), American College of Chest Physicians, Northbrook, IL; the Department of Clinical Epidemiology and Medical Technology Assessment (Dr. Prins), Academis Hospital Maas-tricht, University of Maastricht, Maastricht, the Netherlands; and the and Division of Clinical Research Development and Information Translation (Dr. Schünemann), the Department of Epidemiology, Italian National Cancer Institute Regina Elena, Rome, Italy.

Correspondence to: Gordon Guyatt, MD, MSc, FCCP, Department of Clinical Epidemiology and Biostatistics, HSC-2C12, McMaster University, 1200 Main St West, Hamilton, ON, Canada L8N 3Z5; e-mail: guyatt@mcmaster.ca



Chest. 2006;129(1):182-187. doi:10.1378/chest.129.1.182
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Most panels that develop clinical practice guidelines are poorly equipped to address resource allocation or cost issues associated with management options. This risks neglect, arbitrariness, lack of transparency, and methodological flaws in consideration of resource allocation. We provide recommendations for guideline panels to promote greater transparency and rigor. We suggest focusing on resource allocation issues for only a limited number of recommendations and provide criteria for selecting those in which economic considerations are likely to influence the direction or strength of the recommendation. Panels should involve a health economist to assist with the systematic review and critical interpretation of relevant economic analyses. They should carefully define the intended audience and may consider issuing alternative recommendations when available resources vary widely across target clinical settings. Targeting a limited number of recommendations for the consideration of resource allocation issues, and ensuring methodologically high-quality review, will best serve guideline panels, and the health-care providers and patients they hope to assist.


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