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Population‐Level Cost‐Effectiveness of Implementing Evidence‐Based Practices into Routine Care
Author(s) -
Fortney John C.,
Pyne Jeffrey M.,
Burgess James F.
Publication year - 2014
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12247
Subject(s) - randomized controlled trial , medicine , population , quality adjusted life year , interquartile range , cost effectiveness , environmental health , risk analysis (engineering)
Objective The objective of this research was to apply a new methodology (population‐level cost‐effectiveness analysis) to determine the value of implementing an evidence‐based practice in routine care. Data Sources/Study Setting Data are from sequentially conducted studies: a randomized controlled trial and an implementation trial of collaborative care for depression. Both trials were conducted in the same practice setting and population (primary care patients prescribed antidepressants). Study Design The study combined results from a randomized controlled trial and a pre‐post‐quasi‐experimental implementation trial. Data Collection/Extraction Methods The randomized controlled trial collected quality‐adjusted life years ( QALY s) from survey and medication possession ratios ( MPR s) from administrative data. The implementation trial collected MPR s and intervention costs from administrative data and implementation costs from survey. Principal Findings In the randomized controlled trial, MPR s were significantly correlated with QALY s ( p = .03). In the implementation trial, patients at implementation sites had significantly higher MPR s ( p = .01) than patients at control sites, and by extrapolation higher QALY s (0.00188). Total costs (implementation, intervention) were nonsignificantly higher ($63.76) at implementation sites. The incremental population‐level cost‐effectiveness ratio was $33,905.92/ QALY (bootstrap interquartile range −$45,343.10/ QALY to $99,260.90/ QALY ). Conclusions The methodology was feasible to operationalize and gave reasonable estimates of implementation value.