Extending analytic methods for economic evaluation in implementation science.

Area of Science:

• Health economics
• Implementation science
• Health services research

Background:

• Economic evaluations of health-related evidence-based interventions (EBIs) are infrequent and often use limited quantitative methods.
• Existing studies frequently underestimate the resources needed for EBI implementation and sustainability.
• Inadequate scoping of EBI boundaries and underutilization of context-specific methods contribute to underestimation.

Purpose of the Study:

• To describe methodological opportunities for comprehensive and context-specific economic evaluations of EBI implementation.
• To outline approaches for estimating implementation costs and downstream impacts across different phases.
• To inform decision-making regarding the selection, adoption, adaptation, and sustainment of EBIs.

Main Methods:

• Utilized the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to guide methodological opportunities.
• Employed systems mapping and stakeholder engagement to clarify implementation costs for complex interventions.
• Applied simulation modeling with sensitivity/uncertainty analyses to project health and economic impacts.

Main Results:

• Demonstrated approaches for specifying EBI implementation boundaries and analyzing costs by implementation phase.
• Highlighted the utility of mixed-method approaches, integrating qualitative and quantitative data, for robust economic evaluations.
• Showcased how enhanced data visualization can inform EBI investment and long-term program planning.

Conclusions:

• Calls for increased use of diverse methods, particularly mixed-methods, in economic evaluations of complex EBI implementation.
• Emphasizes the importance of employing these methods across all EPIS phases for accurate cost and outcome estimation.
• Suggests that richer data from integrated approaches can improve decision-making for health programs.