Economic and Resource Use–Related Guidance in US Medical Societies’ Clinical Practice Guidelines

Importance: The extent to which medical societies' clinical practice guidelines (CPGs) provide economic or resource use-related guidance that could inform value-based care is unknown. Objective: To evaluate the proportion of and factors associated with CPG recommendations incorporating economic or resource use-related considerations. Design, Setting, and Participants: This cross-sectional study included CPG documents and recommendations from 23 large US-based medical societies, which were published between January 1, 2019, and December 31, 2023. Data were extracted from April to August 2024 and analyzed from September 2024 to April 2025. Exposures: Recommendation-level characteristics (ie, intervention type); guideline-level characteristics (ie, multisociety effort); society-level characteristics (ie, primary-care vs specialty-care society); and how a society suggested that economic or resource use-related evidence be considered. Main Outcomes and Measures: For each recommendation, the presence of economic or resource use-related guidance in the upfront summary statement or the narrative discussion of the supporting evidence. Odds ratios (ORs) and 95% CIs were calculated to assess factors associated with incorporation of economic or resource use-related considerations. Results: Among 7582 recommendations within 309 CPG documents, 5017 recommendations (66.2%) were treatment-related, 4080 (53.8%) were issued through multisociety efforts, and 286 (3.8%) by primary-care societies. Per the 23 societies' CPG development methods manuals, 14 societies (60.9%) explicitly suggested that economic or resource use-related evidence be considered, 6 (26.1%) ambiguously addressed their approach, and 3 (13.0%) never addressed their approach. Among 7582 recommendations overall, 1706 (22.5%) narratively discussed economic or resource use-related evidence, and 287 (3.8%) contained upfront economic or resource use-related statements. In multilevel multivariable analyses, upfront economic or resource use-related statements were more likely if recommendations were issued by a primary care society (OR, 12.81; 95% CI, 3.37-48.70) or were treatment-related (OR, 1.75; 95% CI, 1.18-2.59) compared with diagnostic-related, and they were less likely if developed by multisociety consensus (OR, 0.18; 95% CI, 0.07-0.47). Narrative economic or resource use-related evidence discussions were more likely if recommendations were issued by societies that explicitly suggested economic or resource use-related evidence be considered (OR, 6.26; 95% CI, 2.16-18.15) compared with societies whose approach was not addressed and less likely if formulated by multisociety consensus (OR, 0.42; 95% CI, 0.23-0.78). Conclusions and Relevance: In this cross-sectional study, most medical societies explicitly suggested that economic or resource use-related evidence be considered when developing CPGs. However, their recommendations infrequently included economic or resource use-related considerations. Higher quality health economic evidence and societies' more explicit consideration of such evidence may allow CPGs to better inform value-based care.