Methods and Practical Considerations for Conducting Budget Impact Analysis for Non-Pharmaceutical Interventions

Background Health technology assessment (HTA) can be conducted at the national, provincial, or hospital level. Although provincial and hospital-based HTAs often focus on non-pharmaceutical interventions, budget impact analysis (BIA) methods for non-pharmaceutical interventions have received less attention in the literature. Methods We reviewed HTAs of non-pharmaceutical interventions published since 2015 by a Canadian provincial HTA agency, evaluating the characteristics and challenges of conducting a BIA. Results We summarized the unique characteristics of BIAs for different categories of interventions, including surgery and other procedures, diagnostic or screening tests, therapeutic programs, and digital health technologies. We then discussed specific methodological and practical considerations for conducting a BIA of a surgical or other hospital-based procedure. Critical points for BIA methods include the following: (1) when estimating the size of a target population, healthcare system capacity must be accounted for, and historical volumes may offer more realistic figures than prevalence and incidence rates; (2) factors that affect the uptake of a new intervention include guideline recommendations, labor and infrastructure requirements for implementation, and the target population size; (3) when interpreting a budget impact that shows cost savings, analysts must address where the savings are generated from and whether they can be reallocated. Some of the considerations discussed may also apply to HTAs of pharmaceuticals. Conclusions When conducting a BIA of a non-pharmaceutical intervention, addressing these methodological considerations may help in better predicting the financial impact of the new intervention for the public payer and guide appropriate budget allocation for healthcare system planning.