title: A Cost-Effectiveness Analysis of Blended Versus Face-to-Face Delivery of Evidence-Based Medicine to Medical Students.
abstract: BACKGROUND
  Blended learning describes a combination of teaching methods, often utilizing digital technologies. Research suggests that learner outcomes can be improved through some blended learning formats. However, the cost-effectiveness of delivering blended learning is unclear.
  
  
  OBJECTIVE
  This study aimed to determine the cost-effectiveness of a face-to-face learning and blended learning approach for evidence-based medicine training within a medical program.
  
  
  METHODS
  The economic evaluation was conducted as part of a randomized controlled trial (RCT) comparing the evidence-based medicine (EBM) competency of medical students who participated in two different modes of education delivery. In the traditional face-to-face method, students received ten 2-hour classes. In the blended learning approach, students received the same total face-to-face hours but with different activities and additional online and mobile learning. Online activities utilized YouTube and a library guide indexing electronic databases, guides, and books. Mobile learning involved self-directed interactions with patients in their regular clinical placements. The attribution and differentiation of costs between the interventions within the RCT was measured in conjunction with measured outcomes of effectiveness. An incremental cost-effectiveness ratio was calculated comparing the ongoing operation costs of each method with the level of EBM proficiency achieved. Present value analysis was used to calculate the break-even point considering the transition cost and the difference in ongoing operation cost.
  
  
  RESULTS
  The incremental cost-effectiveness ratio indicated that it costs 24% less to educate a student to the same level of EBM competency via the blended learning approach used in the study, when excluding transition costs. The sunk cost of approximately AUD $40,000 to transition to the blended model exceeds any savings from using the approach within the first year of its implementation; however, a break-even point is achieved within its third iteration and relative savings in the subsequent years. The sensitivity analysis indicates that approaches with higher transition costs, or staffing requirements over that of a traditional method, are likely to result in negative value propositions.
  
  
  CONCLUSIONS
  Under the study conditions, a blended learning approach was more cost-effective to operate and resulted in improved value for the institution after the third year iteration, when compared to the traditional face-to-face model. The wider applicability of the findings are dependent on the type of blended learning utilized, staffing expertise, and educational context.
authors.affiliation: Monash University, Frankston, Australia. stephen.maloney@monash.edu.
authors.forename: Stephen
authors.identifier: http://orcid.org/0000-0003-2612-5162
authors.initials: S
authors.lastname: Maloney
authors.forename: Peter
authors.identifier: http://orcid.org/0000-0002-5331-7808
authors.initials: P
authors.lastname: Nicklen
authors.forename: George
authors.identifier: http://orcid.org/0000-0001-7262-2587
authors.initials: G
authors.lastname: Rivers
authors.forename: Jonathan
authors.identifier: http://orcid.org/0000-0003-4533-8307
authors.initials: J
authors.lastname: Foo
authors.forename: Ying Ying
authors.identifier: http://orcid.org/0000-0003-2402-6443
authors.initials: YY
authors.lastname: Ooi
authors.forename: Scott
authors.identifier: http://orcid.org/0000-0002-0573-0622
authors.initials: S
authors.lastname: Reeves
authors.forename: Kieran
authors.identifier: http://orcid.org/0000-0003-1268-4676
authors.initials: K
authors.lastname: Walsh
authors.forename: Dragan
authors.identifier: http://orcid.org/0000-0001-5127-9185
authors.initials: D
authors.lastname: Ilic
mesh_terms: D001315:Australia; D003162:Competency-Based Education / Q000191:economics / Q000379:methods / Q000592:standards; D003194:Computer-Assisted Instruction / Q000191:economics* / Q000379:methods* / Q000592:standards; D003362:Cost-Benefit Analysis; D004501:Education, Medical / Q000191:economics* / Q000379:methods* / Q000592:standards; D019317:Evidence-Based Medicine / Q000191:economics* / Q000193:education*; D006801:Humans; D020407:Internet; D008296:Malaysia; D013337:Students, Medical
keywords: eLearning; economic evaluation; evidence-based medicine; medical education