Cost-effectiveness of the Adaptive Implementation of Effective Programs Trial (ADEPT): approaches to adopting implementation strategies.
Cost-effectiveness of the Adaptive Implementation of Effective Programs Trial (ADEPT): approaches to adopting implementation strategies.
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DOI：
10.1186/s13012-020-01069-w
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发表时间：
2020-12-14
期刊：
影响因子：
--
通讯作者：
Kilbourne AM
中科院分区：
文献类型：
--
作者：
Eisman AB;Hutton DW;Prosser LA;Smith SN;Kilbourne AM
以理论为基础的方法支持采用循证实践（ebp）对改善心理健康结果至关重要。实施策略的成本可能很大，但很少有经过严格评估的。本研究的目的是进行成本效益分析，以确定最具成本效益的方法来部署实施策略，以提高对生活目标（一种心理健康EBP）的吸收。我们使用之前进行的一项随机试验的数据来比较复制有效计划（REP）与外部和/或内部促进在对REP无反应的站点中的成本效益。REP是一种低级策略，包括EBP包装、培训和技术援助。外部促进（EF）包括外部专家的支持，而内部促进（IF）通过保护内部员工支持EBP实施的时间来增强外部促进（EF）。我们开发了一个决策树来评估四种实施策略的1年成本和结果：(1)仅REP， (2) REP+EF, (3) REP+EF在需要时添加IF， (4) REP+EF/IF。该分析使用了1年的时间范围，并假设了健康支付者的观点。我们的结果是质量调整生命年（qaly）。经济结果为增量成本效益比（ICER）。我们进行了确定性和概率敏感性分析（PSA）。我们的研究结果表明，REP+EF添加IF是最具成本效益的选择，ICER为593美元/QALY。REP+EF/IF和仅REP+EF条件占主导地位（即，比比较器更昂贵，效果更差）。单向敏感性分析表明，REP+EF和REP+EF添加IF的结果对效用敏感。PSA结果表明，在$100,000/QALY的阈值下，REP+EF，添加IF是30%迭代的最优策略。我们的研究结果表明，最具成本效益的实施支持始于一个不那么密集、成本更低的策略，并根据需要增加EBP的吸收。使用这种方法，可以明智地将实现支持资源分配给最受益的诊所。我们的结果对效用测量的变化并不稳健。需要进行研究，在执行研究中纳入可靠和相关的工具，以确定最具成本效益的战略。本研究通过评估多个实施策略组合的成本和效用，推进了实施的经济评估。ClinicalTrials.gov标识号：nct02151331,05/30/2014。
Theory-based methods to support the uptake of evidence-based practices (EBPs) are critical to improving mental health outcomes. Implementation strategy costs can be substantial, and few have been rigorously evaluated. The purpose of this study is to conduct a cost-effectiveness analysis to identify the most cost-effective approach to deploying implementation strategies to enhance the uptake of Life Goals, a mental health EBP. We used data from a previously conducted randomized trial to compare the cost-effectiveness of Replicating Effective Programs (REP) combined with external and/or internal facilitation among sites non-responsive to REP. REP is a low-level strategy that includes EBP packaging, training, and technical assistance. External facilitation (EF) involves external expert support, and internal facilitation (IF) augments EF with protected time for internal staff to support EBP implementation. We developed a decision tree to assess 1-year costs and outcomes for four implementation strategies: (1) REP only, (2) REP+EF, (3) REP+EF add IF if needed, (4) REP+EF/IF. The analysis used a 1-year time horizon and assumed a health payer perspective. Our outcome was quality-adjusted life years (QALYs). The economic outcome was the incremental cost-effectiveness ratio (ICER). We conducted deterministic and probabilistic sensitivity analysis (PSA). Our results indicate that REP+EF add IF is the most cost-effective option with an ICER of $593/QALY. The REP+EF/IF and REP+EF only conditions are dominated (i.e., more expensive and less effective than comparators). One-way sensitivity analyses indicate that results are sensitive to utilities for REP+EF and REP+EF add IF. The PSA results indicate that REP+EF, add IF is the optimal strategy in 30% of iterations at the threshold of $100,000/QALY. Our results suggest that the most cost-effective implementation support begins with a less intensive, less costly strategy initially and increases as needed to enhance EBP uptake. Using this approach, implementation support resources can be judiciously allocated to those clinics that would most benefit. Our results were not robust to changes in the utility measure. Research is needed that incorporates robust and relevant utilities in implementation studies to determine the most cost-effective strategies. This study advances economic evaluation of implementation by assessing costs and utilities across multiple implementation strategy combinations. ClinicalTrials.gov Identifier: NCT02151331, 05/30/2014.
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影响因子：
4.6
作者：
Kirchner J;Brüne B;Namgaladze D
通讯作者：
Namgaladze D
DOI：
10.1186/s13012-014-0132-x
发表时间：
2014-09-30
期刊：
Implementation science : IS
影响因子：
--
作者：
Kilbourne AM;Almirall D;Eisenberg D;Waxmonsky J;Goodrich DE;Fortney JC;Kirchner JE;Solberg LI;Main D;Bauer MS;Kyle J;Murphy SA;Nord KM;Thomas MR
通讯作者：
Thomas MR
影响因子：
2.3
作者：
Li L;Shen C;Li X;Robins JM
通讯作者：
Robins JM
影响因子：
5.4
作者：
Glick, HA;McBride, L;Bauer, MS
通讯作者：
Bauer, MS
影响因子：
6.6
作者：
Bauer, MS;Altshuler, L;Hauger, R
通讯作者：
Hauger, R