ABSTRACT
This chapter argues that the technical issues relating to the ways in which economics can be incorporated into guidelines and the type of information that should be included. It addresses the quality of economic evidence available and the importance of identifying both the volume and cost of resources. The chapter deals with the decision-making context. It looks at how the same guideline information can be interpreted and implemented at a local decision-making level, where budgets may be fixed in the short term, and at a national priority setting level, where there may be more potential to vary funding. The chapter discusses how the scale of the implementation influences the guideline development process and the problems inherent in unthinking use of cost-effectiveness ratios and cost-per-quality adjusted life year (QALY) thresholds in decision-making. The recommendations are developed first and foremost on the basis of effectiveness and are then tested in terms of the cost-per-QALY implications.
