Best Practice Advice

• High-Value, Cost-Conscious Health Care: Concepts for Clinicians to Evaluate the Benefits, Harms, and Costs of Medical Interventions
• ACP Best Practice Advice:
  A first step toward providing high-value health care is to decrease or discontinue the use of interventions that provide no benefit, such as routine rather than selective imaging in patients with low back pain. While developing guidelines for the ACP, we will highlight interventions that provide little or no benefit and, thus, are likely to be of low value.
  
  A second step is to ensure that we provide interventions that are both effective and decrease costs, such as the use of warfarin in high-risk patients with nonvalvular atrial fibrillation. In the United Kingdom, the National Institute for Health and Clinical Excellence has identified numerous guidance recommendations that may decrease costs, such as better selection of antihypertensive drugs. A registry of cost-effectiveness analyses also contains interventions that are cost-saving.
  
  For interventions that provide additional benefit at additional cost, we recommend assessing their value to patients and society by using cost-effectiveness analyses. Such analyses require specialized expertise and training, are often expensive, and thus are typically performed by investigators. The ACP has previously recommended the inclusion of cost-effectiveness analysis in CER, and we reiterate the importance of the development of such evidence: Evaluation of the cost-effectiveness of interventions provides important additional information for patients and clinicians.
  
  We emphasize that the cost-effectiveness of an intervention should not solely determine its use. There may be ethical or justice-related reasons to provide interventions that do not achieve generally accepted levels of cost-effectiveness; such considerations may outweigh economic concerns. However, we argue that cost-effectiveness should be one factor among others that receives consideration. Higher-cost care does not always mean greater benefit for patients; therefore, we should focus on the value that care provides.