title: Comparing the cost-effectiveness of simulation modalities: a case study of peripheral intravenous catheterization training.
abstract: While the ultimate goal of simulation training is to enhance learning, cost-effectiveness is a critical factor. Research that compares simulation training in terms of educational- and cost-effectiveness will lead to better-informed curricular decisions. Using previously published data we conducted a cost-effectiveness analysis of three simulation-based programs. Medical students (n = 15 per group) practiced in one of three 2-h intravenous catheterization skills training programs: low-fidelity (virtual reality), high-fidelity (mannequin), or progressive (consisting of virtual reality, task trainer, and mannequin simulator). One week later, all performed a transfer test on a hybrid simulation (standardized patient with a task trainer). We used a net benefit regression model to identify the most cost-effective training program via paired comparisons. We also created a cost-effectiveness acceptability curve to visually represent the probability that one program is more cost-effective when compared to its comparator at various 'willingness-to-pay' values. We conducted separate analyses for implementation and total costs. The results showed that the progressive program had the highest total cost (p < 0.001) whereas the high-fidelity program had the highest implementation cost (p < 0.001). While the most cost-effective program depended on the decision makers' willingness-to-pay value, the progressive training program was generally most educationally- and cost-effective. Our analyses suggest that a progressive program that strategically combines simulation modalities provides a cost-effective solution. More generally, we have introduced how a cost-effectiveness analysis may be applied to simulation training; a method that medical educators may use to investment decisions (e.g., purchasing cost-effective and educationally sound simulators).
authors.affiliation: Centre for Excellence in Economic Analysis Research, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Wanrudee
authors.initials: W
authors.lastname: Isaranuwatchai
authors.forename: Ryan
authors.initials: R
authors.lastname: Brydges
authors.forename: Heather
authors.initials: H
authors.lastname: Carnahan
authors.forename: David
authors.initials: D
authors.lastname: Backstein
authors.forename: Adam
authors.initials: A
authors.lastname: Dubrowski
mesh_terms: D002406:Catheterization, Peripheral; D003362:Cost-Benefit Analysis; D004501:Education, Medical / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D013337:Students, Medical; D014584:User-Computer Interface