title: Economic evaluation of active implementation versus guideline dissemination for evidence-based care of acute low-back pain in a general practice setting.
abstract: BACKGROUND
  The development and publication of clinical practice guidelines for acute low-back pain has resulted in evidence-based recommendations that have the potential to improve the quality and safety of care for acute low-back pain. Development and dissemination of guidelines may not, however, be sufficient to produce improvements in clinical practice; further investment in active implementation of guideline recommendations may be required. Further research is required to quantify the trade-off between the additional upfront cost of active implementation of guideline recommendations for low-back pain and any resulting improvements in clinical practice.
  
  
  METHODS
  Cost-effectiveness analysis alongside the IMPLEMENT trial from a health sector perspective to compare active implementation of guideline recommendations via the IMPLEMENT intervention (plus standard dissemination) against standard dissemination alone.
  
  
  RESULTS
  The base-case analysis suggests that delivery of the IMPLEMENT intervention dominates standard dissemination (less costly and more effective), yielding savings of $135 per x-ray referral avoided (-$462.93/3.43). However, confidence intervals around point estimates for the primary outcome suggest that--irrespective of willingness to pay (WTP)--we cannot be at least 95% confident that the IMPLEMENT intervention differs in value from standard dissemination.
  
  
  CONCLUSIONS
  Our findings demonstrate that moving beyond development and dissemination to active implementation entails a significant additional upfront investment that may not be offset by health gains and/or reductions in health service utilization of sufficient magnitude to render active implementation cost-effective.
authors.affiliation: Centre for Health Economics, Monash University, Clayton, Victoria, Australia.
authors.forename: Duncan
authors.initials: D
authors.lastname: Mortimer
authors.forename: Simon D
authors.initials: SD
authors.lastname: French
authors.forename: Joanne E
authors.initials: JE
authors.lastname: McKenzie
authors.forename: Denise A
authors.initials: DA
authors.lastname: O'Connor
authors.forename: Sally E
authors.initials: SE
authors.lastname: Green
mesh_terms: D001315:Australia; D003362:Cost-Benefit Analysis; D058006:General Practice / Q000191:economics / Q000331:legislation & jurisprudence*; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000191:economics* / Q000628:therapy; D017410:Practice Guidelines as Topic; D011859:Radiography; D012017:Referral and Consultation / Q000191:economics