Moving beyond Aim Three: a need for a transdisciplinary approach to build capacity for economic evaluations in implementation science

Abstract

Background Understanding the costs and economic benefits of implementation has been identified by policymakers and researchers as critical to increase the uptake and sustainment of evidence-based practices, but this topic remains relatively understudied. Conducting team science with health economists has been proposed as a solution to increase economic evaluation in implementation science; however, these recommendations ignore the differences in goals and perspectives in these two fields. Our recent qualitative research identified that implementation researchers predominantly approach health economists to examine costs, whereas the majority of health economists expressed limited interest in conducting economic evaluations and a desire to be more integrated within implementation science initiatives. These interviews pointed to challenges in establishing fruitful partnerships when health economists are relegated to the “Third Aim” (i.e., lowest-priority research objective) in implementation science projects by their research partners. Discussion In this debate paper, we argue that implementation researchers and health economists need to focus on team science research principles to expand capacity to address pressing research questions that cut across the two fields. Specifically, we use the four-phase model of transdisciplinary research to outline the goals and processes needed to build capacity in this area (Hall et al., Transl Behav Med 2:415–30, 2012). The first phase focuses on the development of transdisciplinary research teams, including identifying appropriate partners (e.g., considering policy or public health researchers in addition to health economists) and building trust. The conceptual phase focuses on strategies to consider when developing joint research questions and methodology across fields. In the implementation phase, we outline the effective processes for conducting research projects, such as team learning. Finally, in the translation phase, we highlight how a transdisciplinary approach between health economists and implementation researchers can impact real-world practice and policy. Summary The importance of investigating the economic impact of evidence-based practice implementation is widely recognized, but efforts have been limited due to the challenges in conducting team science across disciplines. Training in team science can help advance transdisciplinary efforts, which has the potential to increase the rigor and impact of economic evaluations in implementation science while expanding the roles taken by health economists.

Using decision analysis to support implementation planning in research and practice

“…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].…”

Development of Cost-IS (costing implementation strategies) instrument for digital health solutions: a modified e-Delphi study

“…Despite recent calls for a greater focus on cost within implementation evaluations [3,17], the Implementation Outcome Repository does not yet contain any validated implementation costing instruments [18]. The Repository's criteria likely limited its ability to include costing instruments noting that previous reviews have identi ed eight implementation costing instruments [18].…”

Understanding implementation costs of a pediatric weight management intervention: an economic evaluation protocol

“…Despite the proposed promise of these approaches, it is necessary to understand both the ability of these strategies to improve RE-AIM outcomes as well as the costs and resources needed to execute D&I strategies [ 10 – 12 ]. Unfortunately, study findings from those that have conducted economic evaluations of D&I strategies are mixed and thus the economic feasibility of D&I strategy use remain unclear.…”

“…The recent effort made by the “Economics and Cost” action group of the Consortium for Cancer Implementation Science is an example of this movement. In a series of papers [ 10 – 12 , 18 ], this effort provided common definitions, costing methods, developing costing guidance, and guidance to build collaborations across disciplines [ 19 ]. Complementary to the collection of articles, this paper provides a description of an economic evaluation across various D&I outcomes using RE-AIM [ 7 ] and methods to cost D&I strategies mapped to specific outcomes related to PWMI implementation in micropolitan settings.…”