Most guideline organizations lack explicit guidance in how to incorporate cost considerations

Abstract Background Resource use and cost (RUC) evidence is one of the factors that can be considered when formulating recommendations in clinical practice guidelines (CPGs). However, it is unclear how CPG developers incorporate this information. Purpose To identify available guidance from guideline organizations on how to incorporate RUC in CPGs. Data Sources We searched MEDLINE, the G-I-N library, the Cochrane Methodology Register, and grey literature from inception to 2017. Study selection We included the most recent version of guidance documents. We excluded those that only reported methodology for adapting, endorsing or updating CPGs, and documents reporting methods followed in the development of one or more specific CPGs. Data synthesis We included 77 documents from 67 organizations. Fifty-nine organizations (88.1%) include information regarding RUC during the CPG development process. Fifty-five (82.1%) organizations report taking RUC into account when developing recommendations: 44 (65.7%) do this explicitly, 5 (7.5%) implicitly, and 6 (9.0%) explicitly as optional. Twelve of the 44 organizations that explicitly consider RUC (27.3%) provide guidance to identify, assess and use the RUC evidence when developing recommendations. Twenty-three consider RUC when moving from the evidence to recommendations (52.3%). Seventeen of the 44 (38.6%) recommend making qualitative judgements about whether the desirable effects of interventions were worth the associated costs. Limitations We limited grey literature searches by language. Conclusions More explicit guidance is needed alongside tools to help CPGs developers incorporate RUC evidence when formulating recommendations. Our results may be of use for guideline developers to improve this guidance.