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How to Cost the Implementation of Major System Change for Economic Evaluations: Case Study Using Reconfigurations of Specialist Cancer Surgery in Part of London, England

Author

Listed:
  • Caroline S. Clarke

    (University College London)

  • Cecilia Vindrola-Padros

    (University College London)

  • Claire Levermore

    (University College London Hospitals NHS Foundation Trust)

  • Angus I. G. Ramsay

    (University College London)

  • Georgia B. Black

    (University College London)

  • Kathy Pritchard-Jones

    (University College London Hospitals NHS Foundation Trust
    UCL Partners Academic Health Science Network)

  • John Hines

    (University College London Hospitals NHS Foundation Trust
    University College London, Cancer Collaborative
    Barts Health NHS Trust)

  • Gillian Smith

    (Royal Free London NHS Foundation Trust)

  • Axel Bex

    (Royal Free London NHS Foundation Trust)

  • Muntzer Mughal

    (University College London Hospitals NHS Foundation Trust)

  • David Shackley

    ((hosted by) Christie NHS Foundation Trust
    Manchester Academic Health Science Centre, University of Manchester)

  • Mariya Melnychuk

    (University College London)

  • Steve Morris

    (University of Cambridge)

  • Naomi J. Fulop

    (University College London)

  • Rachael M. Hunter

    (University College London)

Abstract

Background Studies have been published regarding the impact of major system change (MSC) on care quality and outcomes, but few evaluate implementation costs or include them in cost-effectiveness analysis (CEA). This is despite large potential costs of MSC: change planning, purchasing or repurposing assets, and staff time. Implementation costs can influence implementation decisions. We describe our framework and principles for costing MSC implementation and illustrate them using a case study. Methods We outlined MSC implementation stages and identified components, using a framework conceived during our work on MSC in stroke services. We present a case study of MSC of specialist surgery services for prostate, bladder, renal and oesophagogastric cancers, focusing on North Central and North East London and West Essex. Health economists collaborated with qualitative researchers, clinicians and managers, identifying key reconfiguration stages and expenditures. Data sources (n = approximately 100) included meeting minutes, interviews, and business cases. National Health Service (NHS) finance and service managers and clinicians were consulted. Using bottom-up costing, items were identified, and unit costs based on salaries, asset costs and consultancy fees assigned. Itemised costs were adjusted and summed. Results Cost components included options appraisal, bidding process, external review; stakeholder engagement events; planning/monitoring boards/meetings; and making the change: new assets, facilities, posts. Other considerations included hospital tariff changes; costs to patients; patient population; and lifetime of changes. Using the framework facilitated data identification and collection. The total adjusted implementation cost was estimated at £7.2 million, broken down as replacing robots (£4.0 million), consultancy fees (£1.9 million), staff time costs (£1.1 million) and other costs (£0.2 million). Conclusions These principles can be used by funders, service providers and commissioners planning MSC and researchers evaluating MSC. Health economists should be involved early, alongside qualitative and health-service colleagues, as retrospective capture risks information loss. These analyses are challenging; many cost factors are difficult to identify, access and measure, and assumptions regarding lifetime of the changes are important. Including implementation costs in CEA might make MSC appear less cost effective, influencing future decisions. Future work will incorporate this implementation cost into the full CEAs of the London Cancer MSC. Trial Registration Not applicable.

Suggested Citation

  • Caroline S. Clarke & Cecilia Vindrola-Padros & Claire Levermore & Angus I. G. Ramsay & Georgia B. Black & Kathy Pritchard-Jones & John Hines & Gillian Smith & Axel Bex & Muntzer Mughal & David Shackle, 2021. "How to Cost the Implementation of Major System Change for Economic Evaluations: Case Study Using Reconfigurations of Specialist Cancer Surgery in Part of London, England," Applied Health Economics and Health Policy, Springer, vol. 19(6), pages 797-810, November.
  • Handle: RePEc:spr:aphecp:v:19:y:2021:i:6:d:10.1007_s40258-021-00660-6
    DOI: 10.1007/s40258-021-00660-6
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    References listed on IDEAS

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    1. Elisabeth Fenwick & Karl Claxton & Mark Sculpher, 2008. "The Value of Implementation and the Value of Information: Combined and Uneven Development," Medical Decision Making, , vol. 28(1), pages 21-32, January.
    2. Drummond, Michael F. & Sculpher, Mark J. & Claxton, Karl & Stoddart, Greg L. & Torrance, George W., 2015. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 4, number 9780199665884.
    3. Rachael Maree Hunter & Charles Davie & Anthony Rudd & Alan Thompson & Hilary Walker & Neil Thomson & James Mountford & Lee Schwamm & John Deanfield & Kerry Thompson & Bikash Dewan & Minesh Mistry & Sa, 2013. "Impact on Clinical and Cost Outcomes of a Centralized Approach to Acute Stroke Care in London: A Comparative Effectiveness Before and After Model," PLOS ONE, Public Library of Science, vol. 8(8), pages 1-9, August.
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    1. Caroline S. Clarke & Mariya Melnychuk & Angus I. G. Ramsay & Cecilia Vindrola-Padros & Claire Levermore & Ravi Barod & Axel Bex & John Hines & Muntzer M. Mughal & Kathy Pritchard-Jones & Maxine Tran &, 2022. "Cost-Utility Analysis of Major System Change in Specialist Cancer Surgery in London, England, Using Linked Patient-Level Electronic Health Records and Difference-in-Differences Analysis," Applied Health Economics and Health Policy, Springer, vol. 20(6), pages 905-917, November.

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