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ATTRIBUTES OF GOOD PRACTICE GUIDELINES 62 On this last point, limitations in the sources of data and the variables used to project outcomes are likely to provide inspiration for recommending improvements. Projected Costs Recent interest in practice guidelines is founded in part on the explicit or implicit expectation that they can help control escalating health care costs. The committee has already cautioned that some guidelines, if followed, may increase short- or long-term costs and that the net cost effects of current initiatives are not clear. These kinds of uncertainty underscore the desirability of including some form of cost projections in the background documentation for guidelines. Cost estimation, like the projection of health outcomes, has its own special technical complexities and subjective aspects that will often require the services of outside consultants or specialized technical advisory panels. Even with such assistance, the committee recognizes that the results will be imperfect. In general, estimates of the costs associated with a set of guidelines should follow the same principles of documentation and discussion described for the estimation of health outcomes, including comparisons of alternative courses of care (see Figure 3-1). The remainder of this section describes desirable elements of cost projections, elements the committee sees as goals rather than minimum requirements. Ideally, cost estimates should have two components, one involving projected health care costs and the other relating to administrative costs. The estimated health care costs of following the guidelines should reflect (1) the estimated total number of services that will be added, substituted, or deleted if a guideline is followed and (2) the substantiated charges (or production costs) for these services. For example, for screening services, the expected costs of providing the services and of treating the problems that are detected all need to be included. Depending on the available information and the assumptions used, estimates will often take the form of ranges rather than point estimates. If health outcomes are projected in terms of additional life expectancy or similar measures, then the cost per unit of each identified outcome should be projected. Again, ranges may be more suitable than point estimates. If the guidelines indicate acceptable alternative courses of care, the total costs of the major alternatives and their cost per unit of each expected benefit should be described. Cost estimates should also consider the additional expenses that may be associated with administering or using the guidelines. For example, computer hardware or software may be required to support easy access to
