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Malhotra A, Thompson RR, Kagoya F, Masiye F, Mbewe P, Mosepele M, Phiri J, Sambo J, Barker A, Cameron DB, Davila-Roman VG, Effah W, Hutchinson B, Laxy M, Newsome B, Watkins D, Sohn H, Dowdy DW. Economic evaluation of implementation science outcomes in low- and middle-income countries: a scoping review. Implement Sci 2022; 17:76. [PMID: 36384807 PMCID: PMC9670396 DOI: 10.1186/s13012-022-01248-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Historically, the focus of cost-effectiveness analyses has been on the costs to operate and deliver interventions after their initial design and launch. The costs related to design and implementation of interventions have often been omitted. Ignoring these costs leads to an underestimation of the true price of interventions and biases economic analyses toward favoring new interventions. This is especially true in low- and middle-income countries (LMICs), where implementation may require substantial up-front investment. This scoping review was conducted to explore the topics, depth, and availability of scientific literature on integrating implementation science into economic evaluations of health interventions in LMICs. METHODS We searched Web of Science and PubMed for papers published between January 1, 2010, and December 31, 2021, that included components of both implementation science and economic evaluation. Studies from LMICs were prioritized for review, but papers from high-income countries were included if their methodology/findings were relevant to LMIC settings. RESULTS Six thousand nine hundred eighty-six studies were screened, of which 55 were included in full-text review and 23 selected for inclusion and data extraction. Most papers were theoretical, though some focused on a single disease or disease subset, including: mental health (n = 5), HIV (n = 3), tuberculosis (n = 3), and diabetes (n = 2). Manuscripts included a mix of methodology papers, empirical studies, and other (e.g., narrative) reviews. Authorship of the included literature was skewed toward high-income settings, with 22 of the 23 papers featuring first and senior authors from high-income countries. Of nine empirical studies included, no consistent implementation cost outcomes were measured, and only four could be mapped to an existing costing or implementation framework. There was also substantial heterogeneity across studies in how implementation costs were defined, and the methods used to collect them. CONCLUSION A sparse but growing literature explores the intersection of implementation science and economic evaluation. Key needs include more research in LMICs, greater consensus on the definition of implementation costs, standardized methods to collect such costs, and identifying outcomes of greatest relevance. Addressing these gaps will result in stronger links between implementation science and economic evaluation and will create more robust and accurate estimates of intervention costs. TRIAL REGISTRATION The protocol for this manuscript was published on the Open Science Framework. It is available at: https://osf.io/ms5fa/ (DOI: 10.17605/OSF.IO/32EPJ).
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Affiliation(s)
- Akash Malhotra
- grid.21107.350000 0001 2171 9311Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Ryan R. Thompson
- grid.21107.350000 0001 2171 9311Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Faith Kagoya
- grid.463352.50000 0004 8340 3103Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Felix Masiye
- grid.12984.360000 0000 8914 5257University of Zambia, Lusaka, Zambia
| | - Peter Mbewe
- grid.418015.90000 0004 0463 1467Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Mosepele Mosepele
- grid.7621.20000 0004 0635 5486University of Botswana, Gaborone, Botswana
| | - Jane Phiri
- grid.11951.3d0000 0004 1937 1135Ezintsha, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Jairos Sambo
- grid.468776.c0000 0004 5346 0270Cavendish University Zambia, Lusaka, Zambia
| | - Abigail Barker
- grid.4367.60000 0001 2355 7002Washington University in Saint Louis, Saint Louis, MO USA
| | - Drew B. Cameron
- grid.47100.320000000419368710Department of Health Policy and Management, Yale School of Public Health, New Haven, CT USA
| | | | - William Effah
- grid.4367.60000 0001 2355 7002Washington University in Saint Louis, Saint Louis, MO USA
| | - Brian Hutchinson
- grid.62562.350000000100301493Center for Global Noncommunicable Diseases, RTI International, Seattle, WA USA
| | - Michael Laxy
- grid.6936.a0000000123222966Technical University of Munich, Munich, Germany
| | - Brad Newsome
- grid.453035.40000 0004 0533 8254Fogarty International Center (FIC), National Institutes of Health (NIH), Bethesda, MD USA
| | - David Watkins
- grid.34477.330000000122986657University of Washington, Seattle, WA USA
| | - Hojoon Sohn
- grid.31501.360000 0004 0470 5905Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - David W. Dowdy
- grid.21107.350000 0001 2171 9311Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Brundisini F, Zomahoun HTV, Légaré F, Rhéault N, Bernard-Uwizeye C, Massougbodji J, Gogovor A, Tchoubi S, Assan O, Laberge M. Economic evaluations of scaling up strategies of evidence-based health interventions: a systematic review protocol. BMJ Open 2021; 11:e050838. [PMID: 34593499 PMCID: PMC8487175 DOI: 10.1136/bmjopen-2021-050838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Scaling science aims to help roll out evidence-based research results on a wide scale to benefit more individuals. Yet, little is known on how to evaluate economic aspects of scaling up strategies of evidence-based health interventions. METHODS AND ANALYSIS Using the Joanna Briggs Institute guidance on systematic reviews, we will conduct a systematic review of characteristics and methods applied in economic evaluations in scaling up strategies. To be eligible for inclusion, studies must include a scaling up strategy of an evidence-based health intervention delivered and received by any individual or organisation in any country and setting. They must report costs and cost-effectiveness outcomes. We will consider full or partial economic evaluations, modelling and methodological studies. We searched peer-reviewed publications in Medline, Web of Science, Embase, Cochrane Library Database, PEDE, EconLIT, INHATA from their inception onwards. We will search grey literature from international organisations, bilateral agencies, non-governmental organisations, consultancy firms websites and region-specific databases. Two independent reviewers will screen the records against the eligibility criteria and extract data using a pretested extraction form. We will extract data on study characteristics, scaling up strategies, economic evaluation methods and their components. We will appraise the methodological quality of included studies using the BMJ Checklist. We will narratively summarise the studies' descriptive characteristics, methodological strengths/weaknesses and the main drivers of cost-effectiveness outcomes. This study will help identify what are the trade-offs of scaling up evidence-based interventions to allocate resources efficiently. ETHICS AND DISSEMINATION No ethics approval is required as no primary data will be collected. The results will be published in a peer-reviewed, international journal and presented at national and international conferences.
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Affiliation(s)
- Francesca Brundisini
- Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, CIUSSS de la Capitale-Nationale, Quebec, Quebec, Canada
- Operations and Decision Systems, Université Laval, Quebec, Quebec, Canada
| | - Hervé Tchala Vignon Zomahoun
- Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, CIUSSS de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
- VITAM, Centre de recherche en santé durable -Université Laval, CIUSSS de la Capitale-Nationale, Quebec, Quebec, Canada
| | - Nathalie Rhéault
- Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, CIUSSS de la Capitale-Nationale, Quebec, Quebec, Canada
- VITAM, Centre de recherche en santé durable -Université Laval, CIUSSS de la Capitale-Nationale, Quebec, Quebec, Canada
| | - Claude Bernard-Uwizeye
- Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, CIUSSS de la Capitale-Nationale, Quebec, Quebec, Canada
- VITAM, Centre de recherche en santé durable -Université Laval, CIUSSS de la Capitale-Nationale, Quebec, Quebec, Canada
| | - José Massougbodji
- Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, CIUSSS de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
| | - Amédé Gogovor
- Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, CIUSSS de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
| | - Sébastien Tchoubi
- Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, CIUSSS de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
| | - Odilon Assan
- Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, CIUSSS de la Capitale-Nationale, Quebec, Quebec, Canada
- Pharmacy, Université Laval, Quebec, Quebec, Canada
| | - Maude Laberge
- Operations and Decision Systems, Université Laval, Quebec, Quebec, Canada
- VITAM, Centre de recherche en santé durable -Université Laval, CIUSSS de la Capitale-Nationale, Quebec, Quebec, Canada
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