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dc.contributor.authorClarke, Caroline S
dc.contributor.authorVindrola-Padros, Cecilia
dc.contributor.authorLevermore, Claire
dc.contributor.authorRamsay, Angus IG
dc.contributor.authorBlack, Georgia B
dc.contributor.authorPritchard-Jones, Kathy
dc.contributor.authorHines, John
dc.contributor.authorSmith, Gillian
dc.contributor.authorBex, Axel
dc.contributor.authorMughal, Muntzer
dc.contributor.authorShackley, David
dc.contributor.authorMelnychuk, Mariya
dc.contributor.authorMorris, Steve
dc.contributor.authorFulop, Naomi J
dc.contributor.authorHunter, Rachael M
dc.date.accessioned2021-10-28T08:07:19Z
dc.date.available2021-10-28T08:07:19Z
dc.date.issued2021-11
dc.identifier.issn1175-5652
dc.identifier.others40258-021-00660-6
dc.identifier.other660
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/329971
dc.description.abstractBACKGROUND: 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.
dc.languageen
dc.publisherSpringer Science and Business Media LLC
dc.subjectPractical Application
dc.titleHow to Cost the Implementation of Major System Change for Economic Evaluations: Case Study Using Reconfigurations of Specialist Cancer Surgery in Part of London, England.
dc.typeArticle
dc.date.updated2021-10-28T08:07:18Z
prism.endingPage810
prism.issueIdentifier6
prism.publicationNameAppl Health Econ Health Policy
prism.startingPage797
prism.volume19
dc.identifier.doi10.17863/CAM.77415
dcterms.dateAccepted2021-04-23
rioxxterms.versionofrecord10.1007/s40258-021-00660-6
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by-nc/4.0/
dc.contributor.orcidClarke, Caroline S [0000-0002-4676-1257]
dc.contributor.orcidVindrola-Padros, Cecilia [0000-0001-7859-1646]
dc.contributor.orcidRamsay, Angus IG [0000-0002-4446-6916]
dc.contributor.orcidBlack, Georgia B [0000-0003-2676-5071]
dc.contributor.orcidPritchard-Jones, Kathy [0000-0002-2384-9475]
dc.contributor.orcidMorris, Steve [0000-0002-5828-3563]
dc.contributor.orcidFulop, Naomi J [0000-0001-5306-6140]
dc.identifier.eissn1179-1896
pubs.funder-project-idHealth Services and Delivery Research Programme (14/46/19)
cam.issuedOnline2021-05-19


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