title: The value of implementation and the value of information: combined and uneven development.
abstract: OBJECTIVE
  In a budget-constrained health care system, the decision to invest in strategies to improve the implementation of cost-effective technologies must be made alongside decisions regarding investment in the technologies themselves and investment in further research. This article presents a single, unified framework that simultaneously addresses the problem of allocating funds between these separate but linked activities.
  
  
  METHODS
  The framework presents a simple 4-state world where both information and implementation can be either at the current level or "perfect.'' Through this framework, it is possible to determine the maximum return to further research and an upper bound on the value of adopting implementation strategies. The framework is illustrated through case studies of health care technologies selected from those previously considered by the UK National Institute for Health and Clinical Excellence (NICE).
  
  
  RESULTS
  Through the case studies, several key factors that influence the expected values of perfect information and perfect implementation are identified. These factors include the maximum acceptable cost-effectiveness ratio, the level of uncertainty surrounding the adoption decision, the expected net benefits associated with the technologies, the current level of implementation, and the size of the eligible population.
  
  
  CONCLUSIONS
  Previous methods for valuing implementation strategies have not distinguished the value of efficacy research and the value of strategies to change the level of implementation. This framework demonstrates that the value of information and the value of implementation can be examined separately but simultaneously in a single framework. This can usefully inform policy decisions about investment in health care services, further research, and adopting implementation strategies that are likely to differ between technologies.
authors.affiliation: Public Health and Health Policy, University of Glasgow, Glasgow, UK. e.fenwick@clinmed.gla.ac.uk
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Fenwick
authors.forename: Karl
authors.initials: K
authors.lastname: Claxton
authors.forename: Mark
authors.initials: M
authors.lastname: Sculpher
mesh_terms: D022126:Access to Information; D001499:Bayes Theorem; D003362:Cost-Benefit Analysis / Q000379:methods / Q000706:statistics & numerical data; D003657:Decision Making; D003695:Delivery of Health Care / Q000191:economics*; D019317:Evidence-Based Medicine; D006801:Humans; D009936:Organizational Innovation; D006113:United Kingdom