Methods: We searched PubMed, the National Guideline Clearinghouse, the AAAAI website, the ACAAI website, and the Joint Task Force website for practice parameters published over a 5 year period (2010-2015).
Two measures were used to determine how cost has been addressed: (1) what percentage of practice parameters explicitly consider cost in the development of clinical guidelines, measured through review of methodological statements, and (2) what percentage of practice parameters consider cost in specific recommendation justifications.
Results: An inventory of 22 practice parameters were identified.
Of the 22 guidelines, none explicitly integrated cost into their methodology. Eighteen (82%) had no information on cost considerations, and 4 (18%) mentioned language that they explicitly excluded cost from consideration in methodological statements.
Of the 22 guidelines, 14 (64%) had a least 1 recommendation that included language indicating that cost was considered during its development. Eight (36%) did not include any language indicating cost was used to justify any recommendations.
Conclusions: While none of the practice parameters explicitly considered cost in guideline methodology, almost two thirds considered cost to justify specific recommendations. This suggests that cost is important to the specialty, but a standard way of approaching cost has not been well developed and adopted. We propose adoption of explicit cost consideration through use of the GRADE system.