{"id":8844,"date":"2025-10-06T00:25:38","date_gmt":"2025-10-05T21:25:38","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=8844"},"modified":"2025-10-06T00:25:38","modified_gmt":"2025-10-05T21:25:38","slug":"acc-aha-2025-update-on-cost-effectiveness-in-clinical-practice-guidelines","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/acc-aha-2025-update-on-cost-effectiveness-in-clinical-practice-guidelines\/","title":{"rendered":"\u200e\u200fACC\/AHA 2025 Update on Cost-Effectiveness in Clinical Practice Guidelines"},"content":{"rendered":"
\u200e\u200fACC\/AHA 2025 Update on Cost-Effectiveness in Clinical Practice Guidelines<\/div>\n
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Source: ACC and AHA outline calculation of cost-effectiveness in clinical practice guidelines.<\/div>\n
Originally published in Circulation, September 25, 2025.<\/div>\n
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\u200e\u200f1. Background<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>Healthcare costs continue to rise \u2192 new therapies must prove value before adoption.<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>First ACC\/AHA statement in 2014; 2025 = first major update in over 10 years.<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>Update adds:<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>New methods in cost-effectiveness analysis (CEA).<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>Patient-centered outcomes (what matters to patients, not only survival).<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>Health equity focus (fair access across populations).<\/div>\n
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\u2e3b<\/div>\n
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\u200e\u200f2. Historical Context \u2013 Before 2014<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>Before 2014: ACC\/AHA guidelines relied only on Class of Recommendation (COR) and Level of Evidence (LOE).<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>Cost\/value considerations were sometimes mentioned but without a structured framework.<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>2014 Statement: first formal cost-effectiveness methodology, with value levels (High \/ Intermediate \/ Low \/ Uncertain).<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>This marked the start of embedding economic value into cardiology guidelines.<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>Important note: Cost-effectiveness analysis (CEA) itself is not new \u2014 it has existed since the 1970s (e.g.,Milton C. Weinstein \u2013 Harvard professor in health economics and decision sciences, pioneer of cost-effectiveness analysis, NEJM 1977).. What is new is its formal integration into U.S. cardiology guidelines starting in 2014.<\/div>\n
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\u200e\u200f3. Why Cost-Effectiveness Matters<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>Budgets are finite \u2192 funding one therapy means fewer resources for another (opportunity cost).<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>Cardiovascular disease costs in the U.S. may quadruple in 30 years.<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>Careful allocation is critical to maintain both access and quality.<\/div>\n
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\u200e\u200f4. Combining Economics + Clinical Value<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>Economic ROI: money saved vs. money spent.<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>Clinical ROI: lives saved, fewer hospitalizations, improved quality of life.<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>CEA (Cost-Effectiveness Analysis) merges both:<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>Uses QALY (Quality-Adjusted Life Year) = one year of life in good health.<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>Shows cost required to gain each extra QALY.<\/div>\n
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\u200e\u200f5. Thresholds (When Is It \u201cWorth It\u201d?)<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>U.S. practice:<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>< $50,000\/QALY \u2192 highly cost-effective.<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>$50,000\u2013$150,000\/QALY \u2192 acceptable.<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>$150,000\/QALY \u2192 usually not cost-effective (unless life-saving).<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>UK (NICE): \u00a320\u201330k\/QALY.<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>WHO: 1\u20133 \u00d7 GDP per capita\/QALY.<\/div>\n
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\u200e\u200fThis shows how societies decide \u201chow much is worth paying for 1 year of good-quality life.\u201d<\/div>\n
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\u200e\u200f6. Practical Examples<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>High-cost but valuable:<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>New HF drug costing thousands per year but prevents deaths & hospitalizations \u2192 cost-effective.<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>Low-cost but low benefit:<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>Cheap test with little impact on treatment \u2192 not cost-effective.<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>Equity example:<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>Effective device but only accessible to wealthy patients \u2192 raises fairness concerns.<\/div>\n
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\u200e\u200fUpdate Highlights<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>Updated cost-effectiveness thresholds for the U.S. based on latest evidence.<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>Explicit focus on equity: ensure disadvantaged groups are included.<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>Recommend economic value statements for Class I & IIa therapies.<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>Reinforce using U.S.-based cost data for relevance.<\/div>\n
7. How CEA Works \u2013 Comparing Two Groups:<\/div>\n
\u2022 Group A (Standard care): patients on usual therapy.<\/span><\/div>\n
\u2022 Group B (New intervention): patients given the new drug\/device\/procedure.<\/span><\/div>\n
\u2022 Measure difference in outcomes (e.g., death or hospitalization).<\/span><\/div>\n
\u2022 ARR (Absolute Risk Reduction): difference in event rates between groups.<\/span><\/div>\n
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\u2022 NNT (Number Needed to Treat): number of patients that must get the new therapy instead of standard care to prevent 1 extra bad outcome (e.g., death or hospitalization).<\/span><\/div>\n
\u2022 ICER (Incremental Cost-Effectiveness Ratio): compares extra cost with extra health gained. Formula = (Cost of new \u2013 Cost of old) \u00f7 (QALYs with new \u2013 QALYs with old). This shows how much money is needed for each extra year of good-quality life.<\/span><\/div>\n
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\u200e\u200f8. Takeaway<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>Cost-effectiveness is not just about cutting costs.<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>It ensures limited resources produce the maximum health benefit.<\/div>\n
\u200e\u200f <\/span>\u2022 <\/span>The 2025 update merges economic ROI (cost) with clinical ROI (health outcomes) for fairer, smarter guidelines.<\/div>\n
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https:\/\/doi.org\/10.1161\/CIR.0000000000001377<\/a><\/div>\n","protected":false},"excerpt":{"rendered":"

\u200e\u200fACC\/AHA 2025 Update on Cost-Effectiveness in Clinical Practice Guidelines Source: ACC and AHA outline calculation of cost-effectiveness in clinical practice guidelines. Originally published in Circulation, September 25, 2025. . \u200e\u200f1. Background \u200e\u200f \u2022 Healthcare costs continue to rise \u2192 new therapies must prove value before adoption. \u200e\u200f \u2022 First ACC\/AHA statement in 2014; 2025 = […]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-8844","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8844","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=8844"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8844\/revisions"}],"predecessor-version":[{"id":8845,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8844\/revisions\/8845"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=8844"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=8844"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=8844"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}