title: A detailed report of the resource use and costs associated with implementation of a short stay programme for breast cancer surgery.
abstract: BACKGROUND
  Despite the increased attention for assessing the effectiveness of implementation strategies, most implementation studies provide little or no information on its associated costs. The focus of the current study was to provide a detailed report of the resource use and costs associated with implementation of a short stay programme for breast cancer surgery in four Dutch hospitals.
  
  
  METHODS
  The analysis was performed alongside a multi-centre implementation study. The process of identification, measurement and valuation of the implementation activities was based on recommendations for the design, analysis and reporting of health technology assessments. A scoring form was developed to prospectively determine the implementation activities at professional and implementation expert level. A time horizon of 5 years was used to calculate the implementation costs per patient.
  
  
  RESULTS
  Identified activities were consisted of development and execution of the implementation strategy during the implementation project. Total implementation costs over the four hospitals were €83.293. Mean implementation costs, calculated for 660 patients treated over a period of 5 years, were €25 per patient. Subgroup analyses showed that the implementation costs ranged from €3.942 to €32.000 on hospital level. From a local hospital perspective, overall implementation costs were €21 per patient, after exclusion of the costs made by the expert centre.
  
  
  CONCLUSIONS
  We provided a detailed case description of how implementation costs can be determined. Notable differences in implementation costs between hospitals were observed.
  
  
  BACKGROUND
  
  ISRCTN77253391.
authors.affiliation: Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, P.O. box 616, 6200, MD, Maastricht, The Netherlands. stephanie.ament@maastrichtuniversity.nl.|Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, P.O. box 5800, 6202, AZ, Maastricht, The Netherlands. stephanie.ament@maastrichtuniversity.nl.
authors.forename: Stephanie M C
authors.initials: SM
authors.lastname: Ament
authors.affiliation: General Practice centre "Het Anker", Seringenstraat 259, 3142, NV, Maassluis, The Netherlands. maschadekok@hotmail.com.
authors.forename: Mascha
authors.initials: M
authors.lastname: de Kok
authors.affiliation: Department of Surgery, Leiden University Medical Centre, P.O. box 9600, 2033, RC, Leiden, The Netherlands. C.J.H.van_de_Velde@lumc.nl.
authors.forename: Cornelis J H
authors.initials: CJ
authors.lastname: van de Velde
authors.affiliation: Department of Surgery, St. Elisabeth Hospital, P.O. box 90151, 5000, LC, Tilburg, The Netherlands. a.roukema@elisabeth.nl.
authors.forename: Jan A
authors.initials: JA
authors.lastname: Roukema
authors.affiliation: Department of Surgery, Laurentius Hospital, P.O. box 920, 6040, AX, Roermond, The Netherlands. a.bell@lzr.nl.
authors.forename: Toine V R J
authors.initials: TV
authors.lastname: Bell
authors.affiliation: Department of Surgery, Orbis Medical Centre, P.O. box 5500, 6130, MB, Sittard-Geleen, The Netherlands. Fredvanderent@gmail.com.
authors.forename: Fred W
authors.initials: FW
authors.lastname: van der Ent
authors.affiliation: Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, P.O. box 616, 6200, MD, Maastricht, The Netherlands. trudy.vanderweijden@maastrichtuniversity.nl.
authors.forename: Trudy
authors.initials: T
authors.lastname: van der Weijden
authors.affiliation: Department of Surgery, Maastricht University Medical Centre, P.O. box 5800, 6202, AZ, Maastricht, The Netherlands. mf.vonmeyenfeldt@maastrichtuniversity.nl.
authors.forename: Maarten F
authors.initials: MF
authors.lastname: von Meyenfeldt
authors.affiliation: Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, P.O. box 616, 6200, MD, Maastricht, The Netherlands. c.dirksen@mumc.nl.|Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, P.O. box 5800, 6202, AZ, Maastricht, The Netherlands. c.dirksen@mumc.nl.
authors.forename: Carmen D
authors.initials: CD
authors.lastname: Dirksen
mesh_terms: D001943:Breast Neoplasms / Q000191:economics* / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D006739:Hospital Administration / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D009426:Netherlands; D012107:Research Design