What challenges are associated with integrating value assessments into national guidelines?
The integration of value assessments into national guidelines involves inherent methodological challenges, including: 1) variability in costs across different healthcare settings; 2) variability in costs and benefits across different patient subgroups; 3) variability over time; 4) variability in who bears the burden of the health outcome (ie, typically the individual patient) versus who bears the burden of the healthcare cost (eg, often spread beyond the individual to third-party payers, taxpayers); and 5) an inadequate literature base on which to render a sound, evidence-based assessment of certain specific therapies.