Extending analytic methods for economic evaluation in implementation science

Abstract

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.

Using decision analysis to support implementation planning in research and practice

“…Thoughtfully considering how prior literature can inform future decision-making in different contexts is thus core to any decision analysis, and all inputs used throughout a decision analysis should be interrogated and justified [73]. One major area of current focus with implementation science that is often missing detail is the costs of implementation [74][75][76][77]. Recent publications by the "Economics and Cost" action group of the Consortium for Cancer Implementation Science have set out definitions, guidance, methods, and best practices for understanding the costs of implementation and conducting economic evaluations in implementation science [36,74,[77][78][79][80] and complement ongoing work in the field [6,8,12,14,61,75,76,[81][82][83][84].…”

“…One major area of current focus with implementation science that is often missing detail is the costs of implementation [74][75][76][77]. Recent publications by the "Economics and Cost" action group of the Consortium for Cancer Implementation Science have set out definitions, guidance, methods, and best practices for understanding the costs of implementation and conducting economic evaluations in implementation science [36,74,[77][78][79][80] and complement ongoing work in the field [6,8,12,14,61,75,76,[81][82][83][84].…”

Around the EQUATOR with clinician‐scientists transdisciplinary aging research (Clin‐STAR) principles: Implementation science challenges and opportunities

“…For instance, cognitive behavioral therapy for insomnia is generally not well‐reimbursed but is preferred over hypnotic medications due to concerns over falls and other adverse events 39,40 . Investigators should include a health economist on the research team to ensure reasonable assumptions and cost‐analysis approaches are reported 41,42 …”

“…39,40 Investigators should include a health economist on the research team to ensure reasonable assumptions and cost-analysis approaches are reported. 41,42…”

Human resource needs and costs for HIV pre-exposure prophylaxis provision in nurse-led primary care in Eswatini and opportunities for task sharing

“…Information about the human resource needs and costs for PrEP provision can help identify and close potential staffing and financing gaps. Time-and-motion studies are a tool to assess human resource needs and optimize work processes [ 7 ]. We conducted a time-and-motion study to observe and record how health care workers (HCWs) spent time on the provision of PrEP activities during a PrEP demonstration project in Eswatini.…”