Copyright © 2023 International Guidelines Center, Inc., All rights reserved.
70
APPENDIX
COST SAVINGS
Guideline adherence has been shown to reduce costs and improve outcomes across a variety of
conditions:
• Transforming Prior Authorization to Decision-support
Study done by UnitedHealthcare found that by employing a real-time clinical decision-support
mechanism, they were able to ensure guideline adherence and reduce denials from 7% to 1%
among their patient population. Despite increasing that timely access to care and reducing
administrative burden, UnitedHealthcare was able to reduce drug costs to trend by 20%. That was
a savings of $5.3 million. For chemotherapy costs, specifically, across a variety of cancers.
• Total cost of care differences in National Comprehensive Cancer Center (NCCN) concordant
and non-concordant breast cancer patients
CVS Health looked specifically at patients with breast cancer in both the commercial and the
Medicare populations, and found significant cost savings by implementing a clinical decision
support mechanism to ensure guideline adherence among that population and the commercial
population. They saw savings of 25% to 28%. In the Medicare population, they saw a savings of
43%.
• Guideline Discordance and Patient Cost Responsibility in Medicare Beneficiaries With
Metastatic Breast Cancer
Study found patients with breast cancer who receive guideline-adherent care saved approximately
$1800 on average compared with patients who receive guideline-nonadherent care.
THE NEED & SPECIFIC SCENARIOS
• Physician Awareness and Adherence to Clinical Practice Guidelines in the Diagnosis of
Vaginitis
This study found that there were certain vaginitis conditions for which physicians were well aware
of the guidelines but fell short of executing them and others for which a large percentage of
providers were unaware of current recommendations. Differences in practice between OBGYNs
and PCPs also were noted in their methods of evaluating vulvovaginitis complaints. The study
team is particularly concerned regarding the lack of guideline awareness and adherence for
trichomoniasis—the most common non-viral STI in the United States.
• Association of Statewide Implementation of the Prehospital Traumatic Brain Injury
Treatment Guidelines With Patient Survival Following Traumatic Brain Injury
Statewide implementation of the prehospital TBI guidelines was not associated with significant
improvement in overall survival to hospital discharge (across the entire, combined moderate to
critical injury spectrum). However, adjusted survival doubled among patients with severe TBI and
tripled in the severe, intubated cohort. Furthermore, guideline implementation was significantly
associated with survival to hospital admission. These findings support the widespread
implementation of the prehospital TBI treatment guidelines.
Copyright © 2023 International Guidelines Center, Inc., All rights reserved.
