Worthwhile Implementation of Evidence-Based Guidelines into Clinical Practice: How to Determine the Investment Potential for Guideline Implementation and the Value for Money of Implementation Strategies?

Abstract

Given health budget constraints, it becomes increasingly important to determine whether implementing guidelines to change clinical practice is worthwhile. We provide a model (1) to assess the economic impact of non-adherence to guideline recommendations by patients and health care professionals and to determine the total investment potential for guideline implementation. Additionally, the model allows (2) to examine the value for money of implementation strategies to change guideline adherence and to mutually compare the investments in guideline implementation with alternative uses of health care resources. The core value of our model lies in the explicit monetary valuation of health outcomes and the combining of evidence on guidelines and implementation strategies with information on clinical practice. By adopting a total net benefit approach, the model overcomes problems with the use of combined implementation cost-effectiveness ratios at patient level, e.g. when comparing multiple guidelines and multiple strategies across different clinical settings, or when analyzing the uncertainty associated with decision making about clinical practice change. We illustrate the use of our model with a hypothetical example and demonstrate the influence of the cost-effectiveness threshold λ, the baseline guideline adherence and the patient population size on the efficiency of resource allocation.

Keywords: Implementation research, economic evaluation, decision analysis, clinical guidelines, implementation strategies