Clinical guidelines—the hidden costs

The publication of guidelines for statin treatment in the United Kingdom attracted criticism, particularly that no attempt had been made to assess the implications for resources associated with the guidelines. 1 2 The need to evaluate cost and clinical effectiveness in real terms before the widespread use of a treatment is frequently acknowledged.3 Unfortunately, these issues are rarely addressed in clinical guidelines, and there is little evidence that cost effectiveness in practice is considered in drawing up guidelines. 4 5

Surprisingly little consideration has been given to the role of guidelines in a healthcare system in which resources are constrained. 6 7 Cholesterol lowering drugs epitomise the problems that affect clinical guidelines in many areas. We consider here some unintended consequences from the development of guidelines (whether regulatory or … supposedly … advisory) that arise for those funding health care, doctors, and patients.