2.15) The procedure recommended may be associated with additional costs and expenses (e. g. staff, equipment and medication). The answer YES presupposes that at least an estimate of anticipated costs per patient is available.
2.16) An affirmative answer requires a comparison of possible advantages, costs and risks of the recommended intervention. It should be obvious from the presentation that possible disadvantages and costs are outweighed by the anticipated benefit.

2.15) Das empfohlene Vorgehen ist eventuell mit zusätzlichen Kosten und Aufwendungen (z.B. an Personal, Ausstattung und Medikamenten) verbunden. The answer YES presupposes that zumindest eine Schätzung der zu erwartenden Kosten pro Patient vorliegt.
2.16) Die Bejahung dieser Frage verlangt eine Gegenüberstellung der möglichen Vorteile, Kosten und Risiken des empfohlenen Vorgehens. Aus der Darstellung sollte nachvollziehbar sein, dass der erwartete Nutzen die vermuteten Nachteile und Kosten überwiegt.

• Tabelle 17: Kombination von Evidenzgraden und Kosten-Nutzen-Relationen

Kustannukset (Voidaan liittää sopiviin kohtiin, jos ryhmä hallitsee terveystaloudelliset menetelmät)

The health economist should encourage the group to consider the economic consequences of the guideline recommendation as well as the clinical implications. A formal presentation to the group of the basic underlying principles of health economics may be appropriate. It is particularly important that the group understands that economic analysis is not simply a matter of estimating the consequences of a recommendation in terms of use of resources, but is concerned with the evaluation of both costs and health benefits. Assessment of cost-effectiveness is carried out for the purpose of maximising health gain. If resources are employed in interventions that are not cost effective then less health gain is achievable (that is, there is a greater ‘opportunity cost’). The GDG should be encouraged to consider recommendations that:

• are slightly less effective than current practice but that free up a substantial amount of resources that can be reinvested, as well as those that
• increase clinical effectiveness at an acceptable level of increased cost.
  

• Example

SIGN recognises that, in a national health service with limited resources and ever-increasing costs, the ability to cost individual items of care and weigh these against some quantification of patient benefit is important. However, the science of economic analysis of health care is at a relatively early stage and many published studies do not meet the required methodological standard to be incorporated as part of the evidence base for a guideline. Where there is published economic evidence, this has to be identified and evaluated in a consistent manner. Health economic databases are included in the coverage of literature search and studies identified from those searches are evaluated against standard criteria. This evidence can be considered alongside clinical evidence at the considered judgement stage (see item 9).

• Resource implications questionnaire