Linking quality of care and training costs: cost‐effectiveness in health professions education

Abstract

ObjectiveTo provide a model for conducting cost‐effectiveness analyses in medical education. The model was based on a randomised trial examining the effects of training midwives to perform cervical length measurement (CLM) as compared with obstetricians on patients' waiting times. (CLM), as compared with obstetricians.MethodsThe model included four steps: (i) gathering data on training outcomes, (ii) assessing total costs and effects, (iii) calculating the incremental cost‐effectiveness ratio (ICER) and (iv) estimating cost‐effectiveness probability for different willingness to pay (WTP) values. To provide a model example, we conducted a randomised cost‐effectiveness trial. Midwives were randomised to CLM training (midwife‐performed CLMs) or no training (initial management by midwife, and CLM performed by obstetrician). Intervention‐group participants underwent simulation‐based and clinical training until they were proficient. During the following 6 months, waiting times from arrival to admission or discharge were recorded for women who presented with symptoms of pre‐term labour. Outcomes for women managed by intervention and control‐group participants were compared. These data were then used for the remaining steps of the cost‐effectiveness model.ResultsIntervention‐group participants needed a mean 268.2 (95% confidence interval [CI], 140.2‒392.2) minutes of simulator training and a mean 7.3 (95% CI, 4.4‒10.3) supervised scans to attain proficiency. Women who were scanned by intervention‐group participants had significantly reduced waiting time compared with those managed by the control group (n = 65; mean difference, 36.6 [95% CI 7.3‒65.8] minutes; p = 0.008), which corresponded to an ICER of 0.45 EUR minute−1. For WTP values less than EUR 0.26 minute−1, obstetrician‐performed CLM was the most cost‐effective strategy, whereas midwife‐performed CLM was cost‐effective for WTP values above EUR 0.73 minute−1.ConclusionCost‐effectiveness models can be used to link quality of care to training costs. The example used in the present study demonstrated that different training strategies could be recommended as the most cost‐effective depending on administrators' willingness to pay per unit of the outcome variable.

When Are Trainees Ready to Perform Transvaginal Ultrasound? An Observational Study

“…Finally, the equipment costs associated with simulation-based assessments in the present study are probably overestimated as our cost analysis assumed that the simulators were not used for training purposes during the rest of the year. Hence, the real cost of simulation-based assessments is lower when the use of simulators for training purposes during the rest of the year is taken into consideration [17].…”

“…The total equipment costs were estimated for the five simulators used. The equipment cost per participant was depreciated over a five-year period, assuming a constant number of trainees per year [17]. Losses in clinical production due to the use of ultrasound machines for assessment purposes were considered as 'opportunity costs' (the cost associated with the loss of one alternative when another alternative is chosen) [18].…”

New roles for cost as an outcome: opportunities and challenges

“…Considering value as a reflection of cultural standards, patient waiting time or resident satisfaction may be esteemed differently in different hospitals or in different countries in terms of that institution's willingness to pay for the desired outcome. 10 This is, in some respects, just another manifestation of the ubiquitous problem of confounded education research: studies that are so context bound that their findings cannot be meaningfully interpreted and applied outside the authors' institutions. 11 We suspect that in many cases, cost will vary across contexts even more than other education outcomes.…”

The Prato Statement on cost and value in professional and interprofessional education

“…Although method papers for economic evaluation in health professions education are becoming more common, such as Tolsgaard et al (2015) and Haines, Isles, Jones, and Jull (2011), there is currently no comprehensive guide which would allow a novice to comprehend or conduct research in this field. The development of a best practice guide, such as the guide by Sharma, Gordon, Dharamsi, and Gibbs (2015) on conducting systematic reviews, may provide health professions educators and educational researchers the support to incorporate cost and value components into their evaluations.…”