A pragmatic method for costing implementation strategies using time-driven activity-based costing

Abstract

Background Implementation strategies increase the adoption of evidence-based practices, but they require resources. Although information about implementation costs is critical for decision-makers with budget constraints, cost information is not typically reported in the literature. This is at least partly due to a need for clearly defined, standardized costing methods that can be integrated into implementation effectiveness evaluation efforts. Methods We present a pragmatic approach to systematically estimating detailed, specific resource use and costs of implementation strategies that combine time-driven activity-based costing (TDABC), a business accounting method based on process mapping and known for its practicality, with a leading implementation science framework developed by Proctor and colleagues, which guides specification and reporting of implementation strategies. We illustrate the application of this method using a case study with synthetic data. Results This step-by-step method produces a clear map of the implementation process by specifying the names, actions, actors, and temporality of each implementation strategy; determining the frequency and duration of each action associated with individual strategies; and assigning a dollar value to the resources that each action consumes. The method provides transparent and granular cost estimation, allowing a cost comparison of different implementation strategies. The resulting data allow researchers and stakeholders to understand how specific components of an implementation strategy influence its overall cost. Conclusion TDABC can serve as a pragmatic method for estimating resource use and costs associated with distinct implementation strategies and their individual components. Our use of the Proctor framework for the process mapping stage of the TDABC provides a way to incorporate cost estimation into implementation evaluation and may reduce the burden associated with economic evaluations in implementation science.

Bridging the Research to Practice Gap: A Systematic Scoping Review of Implementation of Interventions for Cancer-Related Fatigue Management

“…Cost was another notable implementation outcome that was under-reported, yet is essential when establishing sustainable models of care for cancer survivors. Cost effectiveness, including start-up and ongoing costs of intervention delivery, have been identi ed as key factors in determining the translation of research ndings into practice [53]. However, these costs as notable nancial barriers for sustainability were rarely reported, with only the 'Energy Through Motion' CRF intervention providing an explicit cost of intervention materials ($21.75 USD per patient) [40].…”

“…Future studies need to put greater emphasis on reporting aspects of external validity such as representativeness, setting characteristics, staff level characteristics, and implementation cost. For implementation costs, Cidav and colleagues[53] present a pragmatic approach for costing speci c components of implementation strategies, which may serve as a potential solution to common burdens associated with implementation costing and economic evaluations. Additionally, to ensure program maintenance, investigators should consider sources of ongoing funding and endeavour to use existing resources (staff, equipment, infrastructure, etc.)…”

Cost-Effectiveness Analysis in Implementation Science: a Research Agenda and Call for Wider Application

“…Planning for Implementation, Scaling Up, and Sustaining Impact While calls to explicitly account for the costs attributable to implementation strategies are not novel [51], reporting remains uncommon [23]. Proposals of pragmatic approaches are still recent [52,53], particularly when considering preimplementation activities that may have a direct impact on scale of implementation [54] or program feasibility and sustainability [55]. In estimating costs for implementing combinations of EBIs in HIV/AIDS for six US cities, we derived public health department costs attributable to planning activities to coordinate implementation in local healthcare facilities [9].…”

“…There are a number of high-quality microcosting examples in both the public health [66] and the implementation science literature [54]. Similarly, some studies have proposed approaches for the standardized reporting of preimplementation and implementation component costs [52,54,55,67] but these have not yet been used widely or applied to population-level EBIs. Moreover, CEA typically uses assumptions of constant average costs (i.e., linear cost functions) yet the functional form of costs can matter, particularly for widespread implementation of EBIs [68].…”

A micro costing analysis of the development of a primary care intervention to improve the uptake of diabetic retinopathy screening

“…Where costs are reported, the level of detail on how costs have been identified, measured, and valued is typically sparse [ 6 ]. Of the studies that have tried to specify the resources consumed by various implementation activities, most start from the point of a fully designed or selected implementation strategy [ 8 , 9 ], or focus on resources required for the implementation process [ 10 ]. Intervention costs can accrue long before implementation begins, yet few studies to date have considered these costs [ 11 – 13 ].…”