Scoping review of costs of implementation strategies in community, public health and healthcare settings

Abstract

ObjectivesTo identify existing evidence concerning the cost of dissemination and implementation (D&I) strategies in community, public health and health service research, mapped with the ‘Expert Recommendations for Implementing Change’ (ERIC) taxonomy.DesignScoping review.Data sourcesMEDLINE, EMBASE, CINAHL, PsycINFO, Scopus and the Cochrane Library were searched to identify any English language reports that had been published between January 2008 and December 2019 concerning the cost of D&I strategies.Data extractionWe matched the strategies identified in each article using ERIC taxonomies; further classified them into five areas (eg, dissemination, implementation, integration, capacity building and scale-up); and extracted the corresponding costs (total costs and cots per action target and per evidence-based programme (EBP) participant). We also recorded the reported level of costing methodology used for cost assessment of D&I strategies.ResultsOf the 6445 articles identified, 52 studies were eligible for data extraction. Lack of D&I strategy cost data was the predominant reason (55% of the excluded studies) for study exclusion. Predominant topic, setting, country and research design in the included studies were mental health (19%), primary care settings (44%), the US (35%) and observational (42%). Thirty-five (67%) studies used multicomponent D&I strategies (ranging from two to five discrete strategies). The most frequently applied strategies were Conduct ongoing training (50%) and Conduct educational meetings (23%). Adoption (42%) and reach (27%) were the two most frequently assessed outcomes. The overall costs of Conduct ongoing training ranged from $199 to $105 772 ($1–$13 973 per action target and $0.02–$412 per EBP participant); whereas the cost of Conduct educational meetings ranged from $987 to $1.1–$2.9 million/year ($33–$54 869 per action target and $0.2–$146 per EBP participant). The wide range of costs was due to the varying scales of the studies, intended audiences/diseases and the complexities of the strategy components. Most studies presented limited information on costing methodology, making interpretation difficult.ConclusionsThe quantity of published D&I strategy cost analyses is increasing, yet guidance on conducting and reporting of D&I strategy cost analysis is necessary to facilitate and promote the application of comparative economic evaluation in the field of D&I research.

A systematic review of experimentally tested implementation strategies across health and human service settings: evidence from 2010-2022

“…Moreover, there remains significant variability in how researchers operationalize, apply, and report strategies (individually or in combination) and outcomes [ 21 , 22 ]. Still, synthesizing data related to using individual strategies would help researchers replicate findings and better understand possible mediating factors including the cost, timing, and delivery by specific types of health providers or key partners [ 23 – 25 ]. Such an evidence base would also aid practitioners with implementation planning such as when and how to deploy a strategy for optimal impact.…”

A Cost Analysis of Rethink the Strip

“…A recent scoping review of implementation strategy costs found that multicomponent interventions ranged from $7288 to $3 million. 13 This wide range of costs can be partly attributed to the varying scales, contexts, and settings of the interventions, as well as the complexity of the intervention strategies. Costs ranged from $7570 to $65,335 per clinic for multicomponent interventions focused on primary care clinics.…”

“…Not only do cost analyses provide the cost of employing implementation strategies in a specific setting but they also inform the replication costs of these implementation strategies in other settings 12 . Currently, there is a dearth of literature on implementation strategy costs, particularly from the health care system perspective; a recent scoping review found that among the 52 studies included, only 8 described implementation strategy costs from the perspective of the health care system 13 . It is essential to estimate the costs of these strategies for health care systems to bridge the research-practice gap in using implementation strategies.…”

Implementation strategies to increase human papillomavirus vaccination uptake for adolescent girls in sub-Saharan Africa: A scoping review protocol

“…Some examples of these implementations strategies include; i) conduct educational meetings, defined as “hold meetings targeted toward different stakeholder groups to teach them about the clinical innovation,” ii) build a coalition, defined as “recruit and cultivate relationships with partners in the implementation effort,” iii) access new funding defined as “access new or existing money to facilitate the implementation” [ 33 ]. The ERIC project classification has been used in scoping reviews in other health fields such as dementia [ 34 , 35 ] and costing of implementation strategies [ 36 ] scoping reviews in preference to other taxonomies as it is more detailed with a conceptually clear description of strategies.…”