Criteria for “triaging” clinical guideline recommendations to health economic analysis in Denmark

In late February 2026, the Danish Healthcare Quality Institute (DHQI) released a document describing criteria for triaging clinical guideline recommendations for health economic analysis.

The Council of DHQI has a role in the work on clinical guidelines from clinical societies: it assesses whether the effects of selected, new, or updated guideline recommendations are proportional to the costs and, subsequently, considers the possibility of implementing the recommendations. The Council must therefore support uniform implementation of guidelines across the country. 

To facilitate this process, DHQI has developed a set of criteria designed to identify recommendations that may require health economic analysis and should be submitted to the Council. The scoring framework includes 13 criteria grouped into four domains:

• Evidence and clinical effect – ensures that recommendations are supported by strong scientific evidence (level A or B) and demonstrate meaningful clinical benefits compared with current practice;
• Economic impact – evaluates whether the recommendation substantially increases technology costs, treatment costs per patient, or overall budget impact;
• Implementation and sustainability – assesses potential system-level consequences, such as increased use of imaging, changes in sector responsibilities, additional staffing needs, increased follow-up requirements, or potential inequalities in access to treatment. The domain carries double weight to reflect the importance of implementation feasibility and system capacity;
• Patient acceptance and preferences – considers the impact of the recommendation on patients’ daily lives, treatment preferences, and willingness or ability to follow the intervention.

Each criterion contributes to a cumulative score with a maximum of 18 points. Recommendations reaching the defined threshold (eight points or more) are referred for a health economic analysis conducted by DHQI economists, whereas recommendations scoring below the threshold proceed without further economic evaluation. The threshold will be reassessed over time as experience with the model accumulates.

The full details in Danish can be found here.

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