Value of Implementation of Strategies to Increase the Adherence of Health Professionals and Cancer Survivors to Guideline-Based Physical Exercise

Mewes, Janne C.; Steuten, Lotte Maria Gertruda; IJsbrandy, Charlotte; IJzerman, Maarten Joost

doi:10.1016/j.jval.2017.04.013

Cited by 16 publications

(10 citation statements)

References 51 publications

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“…Case studies, including ours, tend to focus on pharmaceuticals or medical devices, most likely due to the availability of published data and clearly defined patient populations. However, as exemplified by Hoomans and colleagues, [41][42][43][44] who estimated the value of guideline implementation, and Mewes et al, 45 who evaluated the value of increasing adherence to guideline-based physical exercise for cancer survivors, it is possible to apply the EVPIM framework to other and broader implementation assessments. Work has also shown how heterogeneous cost-effectiveness estimates may be addressed in the EVPIM framework 10,11 and the effect of nonlinear costs (e.g., cases where investment in new equipment is needed) and nonlinear effect (e.g., herd immunity from vaccinations) could also be accounted for in EVPIM estimations.…”

Section: Strength and Limitations Of The Proposed Subcategorization Omentioning

confidence: 99%

Subcategorizing the Expected Value of Perfect Implementation to Identify When and Where to Invest in Implementation Initiatives

et al. 2020

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Purpose. Clinical practice variations and low implementation of effective and cost-effective health care technologies are a key challenge for health care systems and may lead to suboptimal treatment and health loss for patients. The purpose of this work was to subcategorize the expected value of perfect implementation (EVPIM) to enable estimation of the absolute and relative value of eliminating slow, low, and delayed implementation. Methods. Building on the EVPIM framework, this work defines EVPIM subcategories to estimate the expected value of eliminating slow, low, or delayed implementation. The work also shows how information on regional implementation patterns can be used to estimate the value of eliminating regional implementation variation. The application of this subcategorization is illustrated by a case study of the implementation of an antiplatelet therapy for the secondary prevention after myocardial infarction in Sweden. Incremental net benefit (INB) estimates are based on published cost-effectiveness assessments and a threshold of SEK 250,000 (£22,300) per quality-adjusted life year (QALY). Results. In the case study, slow, low, and delayed implementation was estimated to represent 22%, 34%, and 44% of the total population EVPIM (2941 QALYs or SEK 735 million), respectively. The value of eliminating implementation variation across health care regions was estimated to 39% of total EVPIM (1138 QALYs). Conclusion. Subcategorizing EVPIM estimates the absolute and relative value of eliminating different parts of suboptimal implementation. By doing so, this approach could help decision makers to identify which parts of suboptimal implementation are contributing most to total EVPIM and provide the basis for assessing the cost and benefit of implementation activities that may address these in future implementation of health care interventions.

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Section: Strength and Limitations Of The Proposed Subcategorization Omentioning

confidence: 99%

Subcategorizing the Expected Value of Perfect Implementation to Identify When and Where to Invest in Implementation Initiatives

et al. 2020

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“…Furthermore, a formalized cooperation with oncology care will be essential (Schmitz et al, 2019). Future research on the implementation of PA programs should focus on how to improve collaboration between oncology care and health promotion and how to ensure that nurses and physicians working in oncology care promote PA for persons undergoing oncology treatment (Mewes et al, 2017;Schmitz et al, 2019;Segal et al, 2017).…”

Section: Implications and Future Researchmentioning

confidence: 99%

The Phys-Can study: meaningful and challenging - supervising physical exercise in a community-based setting for persons undergoing curative oncological treatment

Henriksson

Igelström

Arving

et al. 2020

Physiotherapy Theory and Practice

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Introduction: Supervised exercise may improve physical function and quality of life during oncological treatment. Providing supervised exercise to all patients at hospitals may be impractical, with community-based settings (e.g. public gyms) as a possible alternative. To facilitate implementation, knowledge about the experiences of professionals who deliver exercise programs in community-based settings is crucial. Objective: To explore how physical therapists and personal trainers experience supervising exercise in a community-based setting for persons undergoing curative oncological treatment. Methods: Nine physical therapists and two personal trainers (coaches) were interviewed individually. The semi-structured interviews lasted 33-67 minutes and were analyzed using thematic analysis. Results: Two main themes emerged: "A meaningful task" and "A challenging task," with nine sub-themes. The coaches experienced supervising exercise for persons undergoing treatment as meaningful, as they became a link between oncology care and health promotion. They grew more confident in the role and ascertained that exercising during treatment was feasible. Challenges included managing side effects of treatment and contradictory information from oncology care staff at hospitals, advising patients not to exercise. Conclusion: Supervising exercise for persons undergoing oncological treatment in a communitybased setting may be highly rewarding for professionals who deliver exercise programs, which is promising for implementation. However, patients receive contradictory information about exercise, which may prevent physical activity. Also, supervising exercise for persons undergoing oncological treatment requires skills training; this is suggested for inclusion in educational programs for physical therapists and others. Future research should focus on strategies for cooperation between oncology care and health promotion.

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“…Methods are available to quantify the expected value of the improved implementation of health care interventions using specified strategies, such as investing in the required equipment or staff knowledge. 23,24 Such approaches are henceforth referred to as “implementation strategies.” The evaluation of implementation strategies by estimating the incremental cost-effectiveness ratio was originally proposed by Sculpher 25 in 2000 and further developed by Mason et al 26 in 2001. However, a move in 2007 to propose the use of the net benefit framework by Fenwick et al, 27 formulated by Walker et al, 28 allowed the calculation of the economic benefit of increasing implementation rather than a sole focus on quantifying the relative cost-effectiveness of specific implementation strategies.…”

mentioning

confidence: 99%

“…To date, there have been few actual applications of VOImp, and each has focused on estimating a “static” value, 23,24,32 and none has focused on the impact on precision medicine. Whyte et al 23 estimated the value of using a 2-hour training workshop for clinicians to increase the implementation of NICE guidelines for natriuretic peptide testing.…”

mentioning

confidence: 99%

“…Whyte et al 23 estimated the value of using a 2-hour training workshop for clinicians to increase the implementation of NICE guidelines for natriuretic peptide testing. Mewes et al 24 calculated the incremental net benefit of implementation activities to increase the use of novel oral anticoagulants to prevent strokes. This study extended the VOImp framework to understand the value of implementation in different subgroups of the patient population.…”

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confidence: 99%

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Implementing Interventions with Varying Marginal Cost-Effectiveness: An Application in Precision Medicine

2020

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Purpose. A range of barriers may constrain the effective implementation of strategies to deliver precision medicine. If the marginal costs and consequences of precision medicine vary at different levels of implementation, then such variation will have an impact on relative cost-effectiveness. This study aimed to illustrate the importance and quantify the impact of varying marginal costs and benefits on the value of implementation for a case study in precision medicine. Methods. An existing method to calculate the value of implementation was adapted to allow marginal costs and consequences of introducing precision medicine into practice to vary across differing levels of implementation. This illustrative analysis used a case study based on a published decision-analytic model-based cost-effectiveness analysis of a 70-gene recurrence score (MammaPrint) for breast cancer. The impact of allowing for varying costs and benefits for the value of the precision medicine and of implementation strategies was illustrated graphically and numerically in both static and dynamic forms. Results. The increasing returns to scale exhibited by introducing this specific example of precision medicine mean that a minimum level of implementation (51%) is required for using the 70-gene recurrence score to be cost-effective at a defined threshold of €20,000 per quality-adjusted life year. The observed variation in net monetary benefit implies that the value of implementation strategies was dependent on the initial and ending levels of implementation in addition to the magnitude of the increase in patients receiving the 70-gene recurrence score. In dynamic models, incremental losses caused by low implementation accrue over time unless implementation is improved. Conclusions. Poor implementation of approaches to deliver precision medicine, identified to be cost-effective using decision-analytic model-based cost-effectiveness analysis, can have a significant economic impact on health systems. Developing and evaluating the economic impact of strategies to improve the implementation of precision medicine will potentially realize the more cost-effective use of health care budgets.

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Value of Implementation of Strategies to Increase the Adherence of Health Professionals and Cancer Survivors to Guideline-Based Physical Exercise

Abstract: All the ISTs for cancer survivors, except for financial incentives, had a positive TNB. The largest improvements in adherence were created by a motivational program for patients, followed by a reminder system for professionals.

Cited by 16 publications

References 51 publications

Subcategorizing the Expected Value of Perfect Implementation to Identify When and Where to Invest in Implementation Initiatives

Subcategorizing the Expected Value of Perfect Implementation to Identify When and Where to Invest in Implementation Initiatives

The Phys-Can study: meaningful and challenging - supervising physical exercise in a community-based setting for persons undergoing curative oncological treatment

Implementing Interventions with Varying Marginal Cost-Effectiveness: An Application in Precision Medicine

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