Gold Heather T, Siman Nina, Cuthel Allison M, Nguyen Ann M, Pham-Singer Hang, Berry Carolyn A, Shelley Donna R
Department of Population Health, NYU Langone Health, New York, NY, USA.
Ronald O. Perelman Department of Emergency Medicine, NYU Langone Health, New York, NY, USA.
Implement Sci Commun. 2021 Feb 6;2(1):15. doi: 10.1186/s43058-021-00116-x.
A stepped-wedge, cluster randomized controlled trial assessed the effectiveness of practice facilitation (PF) for adoption of guidelines for prevention and treatment of cardiovascular disease risk factors. This study estimated the associated cost of PF for guideline adoption in small, private primary care practices.
The cost analysis included categories for start-up costs, intervention costs, and practice staff costs for the implemented PF-guided intervention. We estimated the total 1-year costs to operate the program and calculated the mean and range of the cost-per-practice by quarter of the intervention. We estimated the lower and upper bounds for all salary expenses, rounding to the nearest $100.
Total 1-year intervention costs for all 261 practices ranged from $7,900,000 to $10,200,000, with program and practice salaries comprising $6,600,000-$8,400,000 of the total. Start-up costs were a small proportion (3%) of the total 1-year costs. Excluding start-up costs, quarter 1 cost-per-practice was the most expensive at $20,400-$26,700, and quarter 4 was the least expensive at about $10,000. Practice staff time (compared with program staff time) was the majority of the staffing costs at 75-84%.
The PF strategy costs approximately $10,000 per practice per quarter for program and practice costs, once implemented and running at highest efficiency. Whether this program is "worth it" to the decision-maker depends on the relative costs and effectiveness of their other options for improving cardiovascular risk reduction.
This study is retrospectively registered on January 5, 2016, at www.clinicaltrials.gov as NCT02646488 .
一项阶梯楔形整群随机对照试验评估了实践促进（PF）对采用心血管疾病危险因素预防和治疗指南的有效性。本研究估计了在小型私人初级保健机构中采用PF指南的相关成本。
成本分析包括启动成本、干预成本以及实施PF指导干预的实践人员成本等类别。我们估计了运营该项目的1年总成本，并按干预季度计算了每个实践的成本均值和范围。我们估计了所有薪资支出的下限和上限，四舍五入到最接近的100美元。
所有261个实践的1年干预总成本在790万美元至1020万美元之间，其中项目和实践人员薪资占总成本的660万至840万美元。启动成本占1年总成本的比例较小（3%）。不包括启动成本，第1季度每个实践的成本最高，为20400美元至26700美元，第4季度最便宜，约为10000美元。实践人员时间（与项目人员时间相比）占人员成本的大部分，为75%至84%。
一旦实施并高效运行，PF策略每个实践每季度的项目和实践成本约为10000美元。该项目对决策者而言是否“值得”，取决于他们改善心血管疾病风险降低的其他选择的相对成本和有效性。
本研究于2016年1月5日在www.clinicaltrials.gov上进行回顾性注册，注册号为NCT02646488。
