Benchmarking clinical practice on treatment gain inequality-probability bounds

There is widespread concern about low adherence to clinical practice guidelines (CPGs) and the low adoption of new medical technologies. To assist the regulatory response, we propose benchmarking clinical practice on the lower bound on the probability that a recommended treatment/new technology achieves a better outcome. This inequality–probability bound can be estimated from marginal outcome distributions. We illustrate the approach by comparing Swedish cardiologists’ adoption of drug-eluting stents (DESs) with the inequality–probability bound on this technology improving outcomes. A substantial fraction of cardiologists are below the benchmark.