Population-Level Cost-Effectiveness of Implementing Evidence-Based Practices into Routine Care

作者：Fortney John C^*; Pyne Jeffrey M; Burgess James F Jr

来源：Health Services Research, 2014, 49(6): 1832-1851.

DOI：10.1111/1475-6773.12247

• Cost-effectiveness
• implementation
• depression

ObjectiveThe objective of this research was to apply a new methodology (population-level cost-effectiveness analysis) to determine the value of implementing an evidence-based practice in routine care. %26lt;br%26gt;Data Sources/Study SettingData are from sequentially conducted studies: a randomized controlled trial and an implementation trial of collaborative care for depression. Both trials were conducted in the same practice setting and population (primary care patients prescribed antidepressants). %26lt;br%26gt;Study DesignThe study combined results from a randomized controlled trial and a pre-post-quasi-experimental implementation trial. %26lt;br%26gt;Data Collection/Extraction MethodsThe randomized controlled trial collected quality-adjusted life years (QALYs) from survey and medication possession ratios (MPRs) from administrative data. The implementation trial collected MPRs and intervention costs from administrative data and implementation costs from survey. %26lt;br%26gt;Principal FindingsIn the randomized controlled trial, MPRs were significantly correlated with QALYs (p=.03). In the implementation trial, patients at implementation sites had significantly higher MPRs (p=.01) than patients at control sites, and by extrapolation higher QALYs (0.00188). Total costs (implementation, intervention) were nonsignificantly higher ($63.76) at implementation sites. The incremental population-level cost-effectiveness ratio was $33,905.92/QALY (bootstrap interquartile range -$45,343.10/QALY to $99,260.90/QALY). %26lt;br%26gt;ConclusionsThe methodology was feasible to operationalize and gave reasonable estimates of implementation value.

• 出版日期2014-12