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Use of health economic evaluation in the implementation and improvement science fields—a systematic literature review

BACKGROUND: Economic evaluation can inform whether strategies designed to improve the quality of health care delivery and the uptake of evidence-based practices represent a cost-effective use of limited resources. We report a systematic review and critical appraisal of the application of health econ...

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Autores principales: Roberts, Sarah Louise Elin, Healey, Andy, Sevdalis, Nick
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6631608/
https://www.ncbi.nlm.nih.gov/pubmed/31307489
http://dx.doi.org/10.1186/s13012-019-0901-7
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author Roberts, Sarah Louise Elin
Healey, Andy
Sevdalis, Nick
author_facet Roberts, Sarah Louise Elin
Healey, Andy
Sevdalis, Nick
author_sort Roberts, Sarah Louise Elin
collection PubMed
description BACKGROUND: Economic evaluation can inform whether strategies designed to improve the quality of health care delivery and the uptake of evidence-based practices represent a cost-effective use of limited resources. We report a systematic review and critical appraisal of the application of health economic methods in improvement/implementation research. METHOD: A systematic literature search identified 1668 papers across the Agris, Embase, Global Health, HMIC, PsycINFO, Social Policy and Practice, MEDLINE and EconLit databases between 2004 and 2016. Abstracts were screened in Rayyan database, and key data extracted into Microsoft Excel. Evidence was critically appraised using the Quality of Health Economic Studies (QHES) framework. RESULTS: Thirty studies were included—all health economic studies that included implementation or improvement as a part of the evaluation. Studies were conducted mostly in Europe (62%) or North America (23%) and were largely hospital-based (70%). The field was split between improvement (N = 16) and implementation (N = 14) studies. The most common intervention evaluated (43%) was staffing reconfiguration, specifically changing from physician-led to nurse-led care delivery. Most studies (N = 19) were ex-post economic evaluations carried out empirically—of those, 17 were cost effectiveness analyses. We found four cost utility analyses that used economic modelling rather than empirical methods. Two cost-consequence analyses were also found. Specific implementation costs considered included costs associated with staff training in new care delivery pathways, the impacts of new processes on patient and carer costs and the costs of developing new care processes/pathways. Over half (55%) of the included studies were rated ‘good’ on QHES. Study quality was boosted through inclusion of appropriate comparators and reporting of incremental analysis (where relevant); and diminished through use of post-hoc subgroup analysis, limited reporting of the handling of uncertainty and justification for choice of discount rates. CONCLUSIONS: The quantity of published economic evaluations applied to the field of improvement and implementation research remains modest; however, quality is overall good. Implementation and improvement scientists should work closely with health economists to consider costs associated with improvement interventions and their associated implementation strategies. We offer a set of concrete recommendations to facilitate this endeavour.
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spelling pubmed-66316082019-07-24 Use of health economic evaluation in the implementation and improvement science fields—a systematic literature review Roberts, Sarah Louise Elin Healey, Andy Sevdalis, Nick Implement Sci Systematic Review BACKGROUND: Economic evaluation can inform whether strategies designed to improve the quality of health care delivery and the uptake of evidence-based practices represent a cost-effective use of limited resources. We report a systematic review and critical appraisal of the application of health economic methods in improvement/implementation research. METHOD: A systematic literature search identified 1668 papers across the Agris, Embase, Global Health, HMIC, PsycINFO, Social Policy and Practice, MEDLINE and EconLit databases between 2004 and 2016. Abstracts were screened in Rayyan database, and key data extracted into Microsoft Excel. Evidence was critically appraised using the Quality of Health Economic Studies (QHES) framework. RESULTS: Thirty studies were included—all health economic studies that included implementation or improvement as a part of the evaluation. Studies were conducted mostly in Europe (62%) or North America (23%) and were largely hospital-based (70%). The field was split between improvement (N = 16) and implementation (N = 14) studies. The most common intervention evaluated (43%) was staffing reconfiguration, specifically changing from physician-led to nurse-led care delivery. Most studies (N = 19) were ex-post economic evaluations carried out empirically—of those, 17 were cost effectiveness analyses. We found four cost utility analyses that used economic modelling rather than empirical methods. Two cost-consequence analyses were also found. Specific implementation costs considered included costs associated with staff training in new care delivery pathways, the impacts of new processes on patient and carer costs and the costs of developing new care processes/pathways. Over half (55%) of the included studies were rated ‘good’ on QHES. Study quality was boosted through inclusion of appropriate comparators and reporting of incremental analysis (where relevant); and diminished through use of post-hoc subgroup analysis, limited reporting of the handling of uncertainty and justification for choice of discount rates. CONCLUSIONS: The quantity of published economic evaluations applied to the field of improvement and implementation research remains modest; however, quality is overall good. Implementation and improvement scientists should work closely with health economists to consider costs associated with improvement interventions and their associated implementation strategies. We offer a set of concrete recommendations to facilitate this endeavour. BioMed Central 2019-07-15 /pmc/articles/PMC6631608/ /pubmed/31307489 http://dx.doi.org/10.1186/s13012-019-0901-7 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Systematic Review
Roberts, Sarah Louise Elin
Healey, Andy
Sevdalis, Nick
Use of health economic evaluation in the implementation and improvement science fields—a systematic literature review
title Use of health economic evaluation in the implementation and improvement science fields—a systematic literature review
title_full Use of health economic evaluation in the implementation and improvement science fields—a systematic literature review
title_fullStr Use of health economic evaluation in the implementation and improvement science fields—a systematic literature review
title_full_unstemmed Use of health economic evaluation in the implementation and improvement science fields—a systematic literature review
title_short Use of health economic evaluation in the implementation and improvement science fields—a systematic literature review
title_sort use of health economic evaluation in the implementation and improvement science fields—a systematic literature review
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6631608/
https://www.ncbi.nlm.nih.gov/pubmed/31307489
http://dx.doi.org/10.1186/s13012-019-0901-7
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