Economic evaluations performed alongside randomized implementation trials in clinical settings: a systematic review

Area of Science:

• Health Services Research
• Health Economics
• Clinical Trial Methodology

Background:

• Economic evaluations are crucial for comparing implementation strategies in clinical settings to identify cost-effective approaches.
• This systematic review investigates the methodology and quality of economic evaluations embedded within randomized implementation trials.
• The review was prospectively registered with PROSPERO (CRD42023410186).

Purpose of the Study:

• To systematically review and assess the quality of economic evaluations conducted alongside randomized implementation trials in clinical settings.
• To identify common practices in performing economic evaluations within these trials.
• To highlight methodological gaps and provide recommendations for future research.

Main Methods:

• A systematic literature search was performed across seven databases on March 23, 2023.
• Included studies reporting economic evaluations in randomized implementation trials were identified and screened.
• The Drummond Checklist was utilized to evaluate the quality and risk of bias of the economic evaluations.

Main Results:

• Ten studies published between 1990 and 2022 met the inclusion criteria, primarily from North America, the UK, Europe, and Africa.
• Studies were predominantly conducted in primary and out-patient care settings.
• Implementation costs commonly included materials, staffing, and training, with expense and budget reports being the primary data collection method; overall economic methodological quality was medium to high.

Conclusions:

• Economic evidence is vital for healthcare funders and providers to prioritize resource allocation for implementation efforts.
• A limited number of studies may stem from a lack of standardized guidance and terminology for economic evaluations in implementation trials.
• Recommendations include standardized reporting of implementation strategies, adherence to economic evaluation guidelines, and the use of hybrid trial designs to assess both clinical and cost-effectiveness.