Estimating the Cost-Effectiveness of Implementation: Is Sufficient Evidence Available?
BACKGROUND
Timely implementation of recommended interventions can provide health benefits to patients and cost savings to the health service provider. Effective approaches to increase the implementation of guidance are needed. Since investment in activities that improve implementation competes for funding against other health generating interventions, it should be assessed in term of its costs and benefits.


OBJECTIVE
In 2010, the National Institute for Health and Care Excellence released a clinical guideline recommending natriuretic peptide (NP) testing in patients with suspected heart failure. However, its implementation in practice was variable across the National Health Service in England. This study demonstrates the use of multi-period analysis together with diffusion curves to estimate the value of investing in implementation activities to increase uptake of NP testing.


METHODS
Diffusion curves were estimated based on historic data to produce predictions of future utilization. The value of an implementation activity (given its expected costs and effectiveness) was estimated. Both a static population and a multi-period analysis were undertaken.


RESULTS
The value of implementation interventions encouraging the utilization of NP testing is shown to decrease over time as natural diffusion occurs. Sensitivity analyses indicated that the value of the implementation activity depends on its efficacy and on the population size.


CONCLUSIONS
Value of implementation can help inform policy decisions of how to invest in implementation activities even in situations in which data are sparse. Multi-period analysis is essential to accurately quantify the time profile of the value of implementation given the natural diffusion of the intervention and the incidence of the disease.
['Whyte|Sophie|S|', 'Dixon|Simon|S|', 'Faria|Rita|R|', 'Walker|Simon|S|', 'Palmer|Stephen|S|', 'Sculpher|Mark|M|', 'Radford|Stefanie|S|']
D015415:Biomarkers D003362:Cost-Benefit Analysis D003935:Diagnostic Techniques, Cardiovascular D004059:Diffusion of Innovation D004739:England D019317:Evidence-Based Medicine D019983:Guideline Adherence D017048:Health Care Costs D006333:Heart Failure D006801:Humans D018803:Models, Economic D045265:Natriuretic Peptides D017410:Practice Guidelines as Topic D010818:Practice Patterns, Physicians' D011237:Predictive Value of Tests D011379:Prognosis D013222:State Medicine D013997:Time Factors
cost-effectiveness implementation natriuretic peptide (NP) testing heart failure