Economic evaluations of audit and feedback interventions: a systematic review

Abstract

BackgroundThe effectiveness of audit and feedback (A&F) interventions to improve compliance to healthcare guidelines is supported by randomised controlled trials (RCTs) and meta-analyses of RCTs. However, there is currently a knowledge gap on their cost-effectiveness.ObjectiveWe aimed to assess whether A&F interventions targeting improvements in compliance to recommended care are economically favourable.MethodsWe conducted a systematic review including experimental, observational and simulation-based economic evaluation studies of A&F interventions targeting healthcare providers. Comparators were a ‘do nothing’ strategy, or any other intervention not involving A&F or involving a subset of A&F intervention components. We searched MEDLINE, CINAHL, CENTRAL, Econlit, EMBASE, Health Technology Assessment Database, MEDLINE, NHS Economic Evaluation Database, ABI/INFORM, Web of Science, ProQuest and websites of healthcare quality associations to December 2021. Outcomes were incremental cost-effectiveness ratios, incremental cost-utility ratios, incremental net benefit and incremental cost-benefit ratios. Pairs of reviewers independently selected eligible studies and extracted relevant data. Reporting quality was evaluated using CHEERS (Consolidated Health Economic Evaluation Reporting Standards). Results were synthesised using permutation matrices for all studies and predefined subgroups.ResultsOf 13 221 unique citations, 35 studies met our inclusion criteria. The A&F intervention was dominant (ie, at least as effective with lower cost) in 7 studies, potentially cost-effective in 26 and was dominated (ie, the same or less effectiveness and higher costs) in 2 studies. A&F interventions were more likely to be economically favourable in studies based on health outcomes rather than compliance to recommended practice, considering medical costs in addition to intervention costs, published since 2010, and with high reporting quality.DiscussionResults suggest that A&F interventions may have a high potential to be cost-effective. However, as is common in systematic reviews of economic evaluations, publication bias could have led to an overestimation of their economic value.

Implementation Strategies to Promote Short-Course Radiation for Bone Metastases

“…One study ranked audit and feedback as second of 73 strategies in terms of importance and eighth in terms of scalability. In addition, several economic evaluations suggest that audit-and-feedback–based interventions have high potential to be cost-effective . However, multiple recent studies investigating audit and feedback specifically for deimplementation of low-value care have shown less to no effect .…”

“…In addition, several economic evaluations suggest that audit-and-feedback–based interventions have high potential to be cost-effective. 39 However, multiple recent studies investigating audit and feedback specifically for deimplementation of low-value care have shown less to no effect. 40 , 41 In the present study, although initial perceptions regarding its usefulness were relatively low compared with guidelines and eConsults, physicians’ perceptions significantly improved postimplementation, suggesting promise.…”

Implementation of an audit and feedback module targeting low-value clinical practices in a provincial trauma quality assurance program: a cost-effectiveness study

“…Our advisory committee identified 6 scenario-specific sensitivity analyses based on published evidence of A&F effectiveness and context-specific considerations (#1, 2, 3, 6) [ 24 , 26 ] as well as Canadian guidelines on economic evaluation (#4, 5): Adding a virtual facilitation visit once per cycle to help trauma committees identify barriers and facilitators and use them to identify improvement strategies for their action plan; [ 15 , 26 ] Increasing feedback frequency from annually to monthly, as assessed in the systematic review; [ 26 ] Implementing the module only in high-volume trauma centers (i.e., level I and II); Varying the discount rate between 0 and 5%, as recommended by current Canadian guidelines; [ 19 ] Increasing the lifespan of the A&F module to 10 years (Supplementary Fig. 1 ) to take into account the effect of time on module effectiveness.…”

“…Adding a virtual facilitation visit once per cycle to help trauma committees identify barriers and facilitators and use them to identify improvement strategies for their action plan; [ 15 , 26 ]…”

“…Despite this, most A&F interventions, including those used across Canadian trauma systems, are implemented without evidence on their cost-effectiveness [ 12 , 14 ]. A 2022 systematic review summarized evidence on the economic value of A&F interventions in healthcare [ 15 ] and found that they have a high potential to be cost-effective. However, authors only identified economic evaluations for 6% of A&F trials, methodological quality of these evaluations was low, and authors concluded that model-based simulations were urgently needed to assess the impact of A&F characteristics on cost-effectiveness to inform optimal A&F design.…”