John C Fortney1, Jeffrey M Pyne, James F Burgess. 1. Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, AR; South Central Mental Illness Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR; Department of Psychiatry, University of Arkansas for Medical Sciences, North Little Rock, AR.
Abstract
OBJECTIVE: The 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. DATA SOURCES/STUDY SETTING: Data 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). STUDY DESIGN: The study combined results from a randomized controlled trial and a pre-post-quasi-experimental implementation trial. DATA COLLECTION/EXTRACTION METHODS: The 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. PRINCIPAL FINDINGS: In 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). CONCLUSIONS: The methodology was feasible to operationalize and gave reasonable estimates of implementation value. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.
RCT Entities:
OBJECTIVE: The 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. DATA SOURCES/STUDY SETTING: Data 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). STUDY DESIGN: The study combined results from a randomized controlled trial and a pre-post-quasi-experimental implementation trial. DATA COLLECTION/EXTRACTION METHODS: The 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. PRINCIPAL FINDINGS: In 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). CONCLUSIONS: The methodology was feasible to operationalize and gave reasonable estimates of implementation value. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.
Authors: Karl Claxton; Mark Sculpher; Chris McCabe; Andrew Briggs; Ron Akehurst; Martin Buxton; John Brazier; Tony O'Hagan Journal: Health Econ Date: 2005-04 Impact factor: 3.046
Authors: Jonathan A Finkelstein; Paula Lozano; Anne L Fuhlbrigge; Vincent J Carey; Thomas S Inui; Stephen B Soumerai; Sean D Sullivan; Edward H Wagner; Scott T Weiss; Kevin B Weiss Journal: Health Serv Res Date: 2005-12 Impact factor: 3.402
Authors: Chuan-Fen Liu; Lisa V Rubenstein; JoAnn E Kirchner; John C Fortney; Mark W Perkins; Scott K Ober; Jeffrey M Pyne; Edmund F Chaney Journal: Health Serv Res Date: 2009-02 Impact factor: 3.402
Authors: Centaine L Snoswell; Monica L Taylor; Tracy A Comans; Anthony C Smith; Leonard C Gray; Liam J Caffery Journal: J Med Internet Res Date: 2020-10-19 Impact factor: 5.428