Estimating Costs of an Implementation Intervention

Yoon, Jean; Jacobs, Josephine; So, Angela; Kilbourne, Amy M.; Yu, Wei; Goodrich, David E.

doi:10.1177/0272989x20960455

Cited by 26 publications

(44 citation statements)

References 48 publications

(53 reference statements)

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“…There has been a recent surge of publications related to the collection of costs in implementation science [9,14,31,36], and emerging consensus regarding the importance of economic influences on implementation outcomes (see other articles in this collection). This paper contributes to economic evaluation by discussing a range of issues involved in considering implementation costs in the real-world from the perspective of multiple stakeholders to advance both the science and practice of implementation.…”

Section: Discussionmentioning

confidence: 99%

Implementation science issues in understanding, collecting, and using cost estimates: a multi-stakeholder perspective

et al. 2021

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Understanding the resources needed to achieve desired implementation and effectiveness outcomes is essential to implementing and sustaining evidence-based practices (EBPs). Despite this frequent observation, cost and economic measurement and reporting are rare, but becoming more frequent in implementation science, and when present is seldom reported from the perspective of multiple stakeholders (e.g., the organization, supervisory team), including those who will ultimately implement and sustain EBPs.Incorporating a multi-level framework is useful for understanding and integrating the perspectives and priorities of the diverse set of stakeholders involved in implementation. Stakeholders across levels, from patients to delivery staff to health systems, experience different economic impacts (costs, benefit, and value) related to EBP implementation and have different perspectives on these issues. Economic theory can aid in understanding multi-level perspectives and approaches to addressing potential conflict across perspectives.This paper provides examples of key cost components especially important to different types of stakeholders. It provides specific guidance and recommendations for cost assessment activities that address the concerns of various stakeholder groups, identifies areas of agreement and conflict in priorities, and outlines theoretically informed approaches to understanding conflicts among stakeholder groups and processes to address them. Involving stakeholders throughout the implementation process and presenting economic information in ways that are clear and meaningful to different stakeholder groups can aid in maximizing benefits within the context of limited resources. We posit that such approaches are vital to advancing economic evaluation in implementation science. Finally, we identify directions for future research and application.Considering a range of stakeholders is critical to informing economic evaluation that will support appropriate decisions about resource allocation across contexts to inform decisions about successful adoption, implementation, and sustainment. Not all perspectives need to be addressed in a given project but identifying and understanding perspectives of multiple groups of key stakeholders including patients and direct implementation staff not often explicitly considered in traditional economic evaluation are needed in implementation research.

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Section: Discussionmentioning

confidence: 99%

Implementation science issues in understanding, collecting, and using cost estimates: a multi-stakeholder perspective

et al. 2021

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“…In addition, the intervention may require other types of resources such as non-healthcare resources (e.g., transportation or childcare costs), informal care assistance and time, and patient resource costs (including time). Whenever possible, researchers should estimate the intervention costs separately from the implementation costs [ 12 ].…”

Section: Types Of Costs To Consider Measuring For An Implementation Studymentioning

confidence: 99%

“…Estimating costs precisely is time consuming and expensive. Additional precision is necessary when comparing close substitutes and when estimating subgroup effects [ 12 ], but otherwise, it may be unnecessary. Researchers should design their studies with consideration of these trade-offs.…”

Section: Costing: Accuracy and Precisionmentioning

confidence: 99%

Cost data in implementation science: categories and approaches to costing

Gold¹,

McDermott

Hoomans

2022

Implementation Sci

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A lack of cost information has been cited as a barrier to implementation and a limitation of implementation research. This paper explains how implementation researchers might optimize their measurement and inclusion of costs, building on traditional economic evaluations comparing costs and effectiveness of health interventions. The objective of all economic evaluation is to inform decision-making for resource allocation and to measure costs that reflect opportunity costs—the value of resource inputs in their next best alternative use, which generally vary by decision-maker perspective(s) and time horizon(s). Analyses that examine different perspectives or time horizons must consider cost estimation accuracy, because over longer time horizons, all costs are variable; however, with shorter time horizons and narrower perspectives, one must differentiate the fixed and variable costs, with fixed costs generally excluded from the evaluation. This paper defines relevant costs, identifies sources of cost data, and discusses cost relevance to potential decision-makers contemplating or implementing evidence-based interventions. Costs may come from the healthcare sector, informal healthcare sector, patient, participant or caregiver, and other sectors such as housing, criminal justice, social services, and education. Finally, we define and consider the relevance of costs by phase of implementation and time horizon, including pre-implementation and planning, implementation, intervention, downstream, and adaptation, and through replication, sustainment, de-implementation, or spread.

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“…We piloted these tools during the Preparation phase and scheduled periodic observations during the Implementation phase. We used our swimlane diagrams during the Preparation phase to identify other non-labor costs associated with each step and to develop fidelity measures for tracking potential variations or adaptations in EBI implementation, which may have cost implications [ 12 , 47 ]. For each process step, we documented how the associated costs and fidelity steps were to be measured, the frequency of data collection, and where to report the collected data (see Fig.…”

Section: Main Textmentioning

confidence: 99%

“…Another concern is that economic evaluations have often used strictly quantitative approaches to estimate the value of EBIs. Adding qualitative approaches to these studies has potential to address quantitative data limitations [ 1 , 5 , 11 , 12 ]. Dopp and colleagues identified mixed-method opportunities to understand how stakeholders across settings and perspectives interpret findings about implementation costs and cost-effectiveness results (e.g., whether costs collected represent their perspective or seem reasonable), and how implementation resources vary depending on existing infrastructure (e.g., something may or may not have been a cost to them because it was or was not in place) [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Extending analytic methods for economic evaluation in implementation science

et al. 2022

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Background Economic evaluations of the implementation of health-related evidence-based interventions (EBIs) are conducted infrequently and, when performed, often use a limited set of quantitative methods to estimate the cost and effectiveness of EBIs. These studies often underestimate the resources required to implement and sustain EBIs in diverse populations and settings, in part due to inadequate scoping of EBI boundaries and underutilization of methods designed to understand the local context. We call for increased use of diverse methods, especially the integration of quantitative and qualitative approaches, for conducting and better using economic evaluations and related insights across all phases of implementation. Main body We describe methodological opportunities by implementation phase to develop more comprehensive and context-specific estimates of implementation costs and downstream impacts of EBI implementation, using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. We focus specifically on the implementation of complex interventions, which are often multi-level, resource-intensive, multicomponent, heterogeneous across sites and populations, involve many stakeholders and implementation agents, and change over time with respect to costs and outcomes. Using colorectal cancer (CRC) screening EBIs as examples, we outline several approaches to specifying the “boundaries” of EBI implementation and analyzing implementation costs by phase of implementation. We describe how systems mapping and stakeholder engagement methods can be used to clarify EBI implementation costs and guide data collection—particularly important when EBIs are complex. In addition, we discuss the use of simulation modeling with sensitivity/uncertainty analyses within implementation studies for projecting the health and economic impacts of investment in EBIs. Finally, we describe how these results, enhanced by careful data visualization, can inform selection, adoption, adaptation, and sustainment of EBIs. Conclusion Health economists and implementation scientists alike should draw from a larger menu of methods for estimating the costs and outcomes associated with complex EBI implementation and employ these methods across the EPIS phases. Our prior experiences using qualitative and systems approaches in addition to traditional quantitative methods provided rich data for informing decision-making about the value of investing in CRC screening EBIs and long-term planning for these health programs. Future work should consider additional opportunities for mixed-method approaches to economic evaluations.

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Estimating Costs of an Implementation Intervention

Cited by 26 publications

References 48 publications

Implementation science issues in understanding, collecting, and using cost estimates: a multi-stakeholder perspective

Implementation science issues in understanding, collecting, and using cost estimates: a multi-stakeholder perspective

Cost data in implementation science: categories and approaches to costing

Extending analytic methods for economic evaluation in implementation science

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