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How to Invest in Getting Cost-effective Technologies into Practice? A Framework for Value of Implementation Analysis Applied to Novel Oral Anticoagulants

Author

Listed:
  • Rita Faria
  • Simon Walker
  • Sophie Whyte
  • Simon Dixon
  • Stephen Palmer
  • Mark Sculpher

Abstract

Cost-effective interventions are often implemented slowly and suboptimally in clinical practice. In such situations, a range of implementation activities may be considered to increase uptake. A framework is proposed to use cost-effectiveness analysis to inform decisions on how best to invest in implementation activities. This framework addresses 2 key issues: 1) how to account for changes in utilization in the future in the absence of implementation activities; and 2) how to prioritize implementation efforts between subgroups. A case study demonstrates the framework’s application: novel oral anticoagulants (NOACs) for the prevention of stroke in the National Health Service in England and Wales. The results suggest that there is value in additional implementation activities to improve uptake of NOACs, particularly in targeting patients with average or poor warfarin control. At a cost-effectiveness threshold of £20,000 per quality-adjusted life-year (QALY) gained, additional investment in an educational activity that increases the utilization of NOACs by 5% in all patients currently taking warfarin generates an additional 254 QALYs, compared with 973 QALYs in the subgroup with average to poor warfarin control. However, greater value could be achieved with higher uptake of anticoagulation more generally: switching 5% of patients who are potentially eligible for anticoagulation but are currently receiving no treatment or are using aspirin would generate an additional 4990 QALYs. This work can help health services make decisions on investment at different points of the care pathway or across disease areas in a manner consistent with the value assessment of new interventions.

Suggested Citation

  • Rita Faria & Simon Walker & Sophie Whyte & Simon Dixon & Stephen Palmer & Mark Sculpher, 2017. "How to Invest in Getting Cost-effective Technologies into Practice? A Framework for Value of Implementation Analysis Applied to Novel Oral Anticoagulants," Medical Decision Making, , vol. 37(2), pages 148-161, February.
    • Handle: RePEc:sae:medema:v:37:y:2017:i:2:p:148-161
    DOI: 10.1177/0272989X16645577
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    References listed on IDEAS

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    1. Afschin Gandjour, 2010. "Investment in quality improvement: how to maximize the return," Health Economics, John Wiley & Sons, Ltd., vol. 19(1), pages 31-42, January.
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    Cited by:

    1. Sean P. Gavan & Stuart J. Wright & Fiona Thistlethwaite & Katherine Payne, 2023. "Capturing the Impact of Constraints on the Cost-Effectiveness of Cell and Gene Therapies: A Systematic Review," PharmacoEconomics, Springer, vol. 41(6), pages 675-692, June.
    2. James Love-Koh & Susan Griffin & Edward Kataika & Paul Revill & Sibusiso Sibandze & Simon Walker & Jessica Ochalek & Mark Sculpher & Matthias Arnold, 2019. "Economic analysis for health benefits package design," Working Papers 165cherp, Centre for Health Economics, University of York.
    3. Jeremy D. Goldhaber-Fiebert & Lauren E. Cipriano, 2023. "Pricing Treatments Cost-Effectively when They Have Multiple Indications: Not Just a Simple Threshold Analysis," Medical Decision Making, , vol. 43(7-8), pages 914-929, October.
    4. Kasper Johannesen & Magnus Janzon & Tomas Jernberg & Martin Henriksson, 2020. "Subcategorizing the Expected Value of Perfect Implementation to Identify When and Where to Invest in Implementation Initiatives," Medical Decision Making, , vol. 40(3), pages 327-338, April.

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