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A Reconciled Method for Evaluating the Cost-Effectiveness of Implementation Programmes: Illustrated by Quality
Carlos Sillero-Rejon1,2, William Hollingworth3,4, Brent C Opmeer3,5
1National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust. Whitefriars Level 9, Lewins Mead, Bristol, BS12NT, UK. carlos.sillerorejon@bristol.ac.uk.
Background:
Methods for the economic evaluation of implementation initiatives to increase the uptake of cost-effective healthcare interventions are not standardised. Value of implementation and policy cost-effectiveness are two proposed approaches. This research aims to compare these two methods and propose a standardised approach. To illustrate this, we evaluated two implementation programmes to increase magnesium sulphate (MgSO4) uptake in preterm labour to reduce the risk of cerebral palsy: (i) the National PReCePT Programme (NPP), which provided regional support and funded clinical time in maternity units in England, and (ii) an enhanced support programme (ESP) with additional unit-level coaching and extra funded time, which was nested within the NPP and subject to a cluster randomised control trial.
Methods:
After summarising value of implementation and policy cost-effectiveness methods, we explored the extent to which the two methods can be viewed as mathematically equivalent for the purpose of evaluating the NPP (versus pre-existing trends) and the ESP (versus the NPP) calculating their incremental cost-effectiveness ratios, net monetary benefits and their probability of being cost-effective.
Results:
We demonstrate how the value of implementation and policy cost-effectiveness approaches can be expressed in equivalent terms and set out our standardised stepwise method for evaluating the NPP (versus pre-existing trends) and the ESP (versus the NPP). Our method found that the NPP generated a net monetary benefit of £30,247 per maternity unit over 12 months, with a 98% probability of being cost-effective. In contrast, the ESP generated a net monetary loss of £28,682 per unit compared with the NPP, with a 22% probability of being cost-effective.
Discussion:
Our standardised method could promote a more systematic assessment of the value for money of implementation interventions.
