title: A cost-effectiveness analysis of self-debriefing versus instructor debriefing for simulated crises in perioperative medicine in Canada.
abstract: OBJECTIVE
  High-fidelity simulation training is effective for learning crisis resource management (CRM) skills, but cost is a major barrier to implementing high-fidelity simulation training into the curriculum. The aim of this study was to examine the cost-effectiveness of self-debriefing and traditional instructor debriefing in CRM training programs and to calculate the minimum willingness-to-pay (WTP) value when one debriefing type becomes more cost-effective than the other.
  
  
  METHODS
  This study used previous data from a randomized controlled trial involving 50 anesthesiology residents in Canada. Each participant managed a pretest crisis scenario. Participants who were randomized to self-debrief used the video of their pretest scenario with no instructor present during their debriefing. Participants from the control group were debriefed by a trained instructor using the video of their pretest scenario. Participants individually managed a post-test simulated crisis scenario. We compared the cost and effectiveness of self-debriefing versus instructor debriefing using net benefit regression. The cost-effectiveness estimate was reported as the incremental net benefit and the uncertainty was presented using a cost-effectiveness acceptability curve.
  
  
  RESULTS
  Self-debriefing costs less than instructor debriefing. As the WTP increased, the probability that self-debriefing would be cost-effective decreased. With a WTP ≤Can$200, the self-debriefing program was cost-effective. However, when effectiveness was priced higher than cost-savings and with a WTP >Can$300, instructor debriefing was the preferred alternative.
  
  
  CONCLUSIONS
  With a lower WTP (≤Can$200), self-debriefing was cost-effective in CRM simulation training when compared to instructor debriefing. This study provides evidence regarding cost-effectiveness that will inform decision-makers and clinical educators in their decision-making process, and may help to optimize resource allocation in education.
authors.affiliation: Centre for Excellence in Economic Analysis Research, The HUB Health Research Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Ontario, Canada.|Institute for Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.
authors.forename: Wanrudee
authors.identifier: 0000-0002-8368-6065
authors.initials: W
authors.lastname: Isaranuwatchai
authors.affiliation: Department of Anesthesia, Sunnybrook Health Sciences Centre, Ontario, Canada.|The Wilson Centre for Research in Medical Education, University of Toronto, Ontario, Canada.
authors.forename: Fahad
authors.identifier: 0000-0001-9300-5713
authors.initials: F
authors.lastname: Alam
authors.affiliation: Centre for Excellence in Economic Analysis Research, The HUB Health Research Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Ontario, Canada.|Institute for Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.
authors.forename: Jeffrey
authors.identifier: 0000-0002-4880-4281
authors.initials: J
authors.lastname: Hoch
authors.affiliation: Department of Anesthesiology, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ontario, Canada.|Department of Innovation in Medical Innovation, University of Ottawa, Ontario, Canada.
authors.forename: Sylvain
authors.identifier: 0000-0002-1679-818X
authors.initials: S
authors.lastname: Boet
mesh_terms: D000776:Anesthesiology / Q000193:education*; D002170:Canada; D002983:Clinical Competence; D003362:Cost-Benefit Analysis; D006801:Humans; D007858:Learning; D059035:Perioperative Period / Q000193:education*; D040841:Resource Allocation; D000066908:Simulation Training / Q000191:economics*
keywords: Anesthesiology; Canada; Cost-benefit analysis; Resource allocation; Simulation training