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Economic Evaluation of Active Implementation versus Guideline Dissemination for Evidence-Based Care of Acute Low-Back Pain in a General Practice Setting

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Listed:
  • Duncan Mortimer
  • Simon D French
  • Joanne E McKenzie
  • Denise A O′Connor
  • Sally E Green

Abstract

Introduction: The development and publication of clinical practice guidelines for acute low-back pain has resulted in evidence-based recommendations that have the potential to improve the quality and safety of care for acute low-back pain. Development and dissemination of guidelines may not, however, be sufficient to produce improvements in clinical practice; further investment in active implementation of guideline recommendations may be required. Further research is required to quantify the trade-off between the additional upfront cost of active implementation of guideline recommendations for low-back pain and any resulting improvements in clinical practice. Methods: Cost-effectiveness analysis alongside the IMPLEMENT trial from a health sector perspective to compare active implementation of guideline recommendations via the IMPLEMENT intervention (plus standard dissemination) against standard dissemination alone. Results: The base-case analysis suggests that delivery of the IMPLEMENT intervention dominates standard dissemination (less costly and more effective), yielding savings of $135 per x-ray referral avoided (-$462.93/3.43). However, confidence intervals around point estimates for the primary outcome suggest that – irrespective of willingness to pay (WTP) – we cannot be at least 95% confident that the IMPLEMENT intervention differs in value from standard dissemination. Conclusions: Our findings demonstrate that moving beyond development and dissemination to active implementation entails a significant additional upfront investment that may not be offset by health gains and/or reductions in health service utilization of sufficient magnitude to render active implementation cost-effective.

Suggested Citation

  • Duncan Mortimer & Simon D French & Joanne E McKenzie & Denise A O′Connor & Sally E Green, 2013. "Economic Evaluation of Active Implementation versus Guideline Dissemination for Evidence-Based Care of Acute Low-Back Pain in a General Practice Setting," PLOS ONE, Public Library of Science, vol. 8(10), pages 1-8, October.
  • Handle: RePEc:plo:pone00:0075647
    DOI: 10.1371/journal.pone.0075647
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    References listed on IDEAS

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    1. Hoeijenbos, Margreet & Bekkering, Trudy & Lamers, Leida & Hendriks, Erik & van Tulder, Maurits & Koopmanschap, Marc, 2005. "Cost-effectiveness of an active implementation strategy for the Dutch physiotherapy guideline for low back pain," Health Policy, Elsevier, vol. 75(1), pages 85-98, December.
    2. Luke Vale & Ruth Thomas & Graeme MacLennan & Jeremy Grimshaw, 2007. "Systematic review of economic evaluations and cost analyses of guideline implementation strategies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 8(2), pages 111-121, June.
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    4. Simon D French & Joanne E McKenzie & Denise A O'Connor & Jeremy M Grimshaw & Duncan Mortimer & Jill J Francis & Susan Michie & Neil Spike & Peter Schattner & Peter Kent & Rachelle Buchbinder & Matthew, 2013. "Evaluation of a Theory-Informed Implementation Intervention for the Management of Acute Low Back Pain in General Medical Practice: The IMPLEMENT Cluster Randomised Trial," PLOS ONE, Public Library of Science, vol. 8(6), pages 1-15, June.
    5. Glick, Henry A & Doshi, Jalpa A & Sonnad, Seema S & Polsky, Daniel, 2007. "Economic Evaluation in Clinical Trials," OUP Catalogue, Oxford University Press, number 9780198529972.
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