Welfare gains and losses caused by clinical practice

Clinical practice guidelines (CPGs) for health professionals can have a variety of welfare implications. These may result from a reduction in practice variation in the form of overuse, underuse and misuse or a shift in resources between patient groups. The purpose of this article is to discuss welfare gains and losses caused by CPGs for health professionals. To this end, the article distinguishes between CPGs with and without the inclusion of economic evidence. Based on a framework, this article shows that CPGs, which include economic evidence, can actually lead to a welfare loss by misjudging the maximum cost–effectiveness threshold or ignoring altruistic concerns for patients. Given that a significant portion of CPGs currently considers costs and cost–effectiveness of treatment, this practice may need to be reassessed in jurisdictions where a cost–effectiveness threshold has not been appropriately defined and a public consensus on the trade-off between cost–effectiveness and equity does not yet exist.