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Purpose: To develop a framework to inform the separate but linked policy decisions regarding investment in healthcare services, further research and strategies to ensure appropriate implementation of health technologies given existing evidence.
Methods: In a budget constrained healthcare system the decision to invest in implementation strategies must be made alongside those regarding investment in healthcare services and further research. We present a framework that examines the value of further information and the value of implementation strategies separately but simultaneously. We provide a measure of the maximum return to further research (expected value of perfect information: EVPI) and an upper bound on the value of adopting implementation strategies (expected value of perfect implementation: EVPImp). This framework is demonstrated using a series of health care technologies selected from those previously considered by the UK National Institute for Clinical Excellence (NICE) including: Orlistat for obesity, Zanamivir for influenza and prophylactic extraction of wisdom teeth. The information used for the case studies was taken from the NICE guidance and assessment reports.
Results: In the case of wisdom teeth the value of further research is low (EVPI = £0) but the value of adopting appropriate implementation strategies is substantial (EVPImp = £20m). In other circumstances, investment is worthwhile in both further research and implementation strategies, e.g. in the case of Zanamivir further clinical trials are worthwhile (EVPI = £6m) as are strategies to restrict use to high risk groups presenting within 24 hours on symptom onset (EVPImp = £3.5m). Similarly in the case of Orlistat, there is considerable value of adopting implementation strategies that ensure that only patients who maintain the required weight loss continue to receive the drug (EVPImp = £11m).
Conclusions: Previous methods for valuing implementation strategies have confused the value of research and the value of implementation. This framework demonstrates that the value of information and the value of implementation can be examined separately but simultaneously in a single framework. This can usefully inform policy decisions about investment in healthcare services, further research and adopting implementation strategies.
See more of Oral Concurrent Session B - Methodological Advances
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)