Dr Mark Hlatky Discusses Cost-Effectiveness Analysis in Cardiology

Although cost-effectiveness analysis has not been a formal part of cardiology clinical guidelines until recently, it has "always been the elephant in the room," said Mark Hlatky, MD, professor of health research and policy and professor of cardiovascular medicine at Stanford University.

Transcript (slightly modified for readability)

How much does cost effectiveness come into consideration when creating and utilizing cardiology clinical guidelines?

Cost-effectiveness analysis has not been formally part of clinical guidelines until just recently. I think it's always been the elephant in the room, where people understood that if it is a costly therapy, we need to take into account whether it was really providing any value. But there was no formal mechanism for doing that. The American College of Cardiology and the American Heart Association recently adopted the idea that we would, in fact, put value grades in for therapies that were judged to be highly effective therapies. We also try to assess their value and incorporate some recognition of the value statement into our guidelines. That's going to happen going forward.

In what ways can cost effectiveness be better utilized when creating new cardiology clinical guidelines?

One of the things that we have an issue for is we are evidence-based and we're not going to be commissioning models of developing things specifically to support the guidelines. So we're going to have to take what's been done already. I think ISPOR and other organizations can be extremely helpful in helping us understand what good studies are and having a way to grade the evidence on this. I think economic evaluations are very complicated sometimes and very difficult to assess and I think we need to figure out ways to make them simpler and to make them credible so they can go and support the guideline.