title: Estimating the Cost-Effectiveness of Implementation: Is Sufficient Evidence Available?
abstract: BACKGROUND
  Timely implementation of recommended interventions can provide health benefits to patients and cost savings to the health service provider. Effective approaches to increase the implementation of guidance are needed. Since investment in activities that improve implementation competes for funding against other health generating interventions, it should be assessed in term of its costs and benefits.
  
  
  OBJECTIVE
  In 2010, the National Institute for Health and Care Excellence released a clinical guideline recommending natriuretic peptide (NP) testing in patients with suspected heart failure. However, its implementation in practice was variable across the National Health Service in England. This study demonstrates the use of multi-period analysis together with diffusion curves to estimate the value of investing in implementation activities to increase uptake of NP testing.
  
  
  METHODS
  Diffusion curves were estimated based on historic data to produce predictions of future utilization. The value of an implementation activity (given its expected costs and effectiveness) was estimated. Both a static population and a multi-period analysis were undertaken.
  
  
  RESULTS
  The value of implementation interventions encouraging the utilization of NP testing is shown to decrease over time as natural diffusion occurs. Sensitivity analyses indicated that the value of the implementation activity depends on its efficacy and on the population size.
  
  
  CONCLUSIONS
  Value of implementation can help inform policy decisions of how to invest in implementation activities even in situations in which data are sparse. Multi-period analysis is essential to accurately quantify the time profile of the value of implementation given the natural diffusion of the intervention and the incidence of the disease.
authors.affiliation: The School of Health and Related Research, University of Sheffield, Sheffield, UK. Electronic address: Sophie.whyte@sheffield.ac.uk.
authors.forename: Sophie
authors.initials: S
authors.lastname: Whyte
authors.affiliation: The School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Dixon
authors.affiliation: Centre for Health Economics, University of York, York, UK.
authors.forename: Rita
authors.initials: R
authors.lastname: Faria
authors.affiliation: Centre for Health Economics, University of York, York, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Walker
authors.affiliation: Centre for Health Economics, University of York, York, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Palmer
authors.affiliation: Centre for Health Economics, University of York, York, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Sculpher
authors.affiliation: NHS England, London, UK.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Radford
mesh_terms: D015415:Biomarkers / Q000097:blood; D003362:Cost-Benefit Analysis; D003935:Diagnostic Techniques, Cardiovascular / Q000191:economics* / Q000592:standards; D004059:Diffusion of Innovation; D004739:England; D019317:Evidence-Based Medicine / Q000191:economics* / Q000592:standards; D019983:Guideline Adherence / Q000191:economics* / Q000592:standards; D017048:Health Care Costs / Q000592:standards; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000191:economics*; D006801:Humans; D018803:Models, Economic; D045265:Natriuretic Peptides / Q000097:blood*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000191:economics; D011237:Predictive Value of Tests; D011379:Prognosis; D013222:State Medicine / Q000191:economics; D013997:Time Factors
chemical_list: D015415:Biomarkers; D045265:Natriuretic Peptides
keywords: cost-effectiveness; heart failure; implementation; natriuretic peptide (NP) testing