Wynne Olivia, Szewczyk Zoe, Hollis Jenna, Farragher Eva, Doherty Emma, Tully Belinda, Paolucci Francesco, Gillham Karen, Reeves Penny, Wiggers John, Kingsland Melanie
Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia.
School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
Implement Sci Commun. 2023 Apr 18;4(1):40. doi: 10.1186/s43058-023-00420-8.
Antenatal clinical practice guidelines recommend routine assessment of weight and provision of advice on recommended weight gain during pregnancy and referral to additional services when appropriate. However, there are barriers to clinicians adopting such best-practice guidelines. Effective, cost-effective, and affordable implementation strategies are needed to ensure the intended benefits of guidelines are realised. This paper describes the protocol for evaluating the efficiency and affordability of implementation strategies compared to the usual practice in public antenatal services.
The prospective trial-based economic evaluation will identify, measure, and value key resource and outcome impacts arising from the implementation strategies compared with usual practice. The evaluation will comprise of (i) costing, (ii) cost-consequence analyses, where a scorecard approach will be used to show the costs and benefits given the multiple primary outcomes included in the trial, and (iii) cost-effectiveness analysis, where the primary outcome will be incremental cost per percent increase in participants reporting receipt of antenatal care for gestational weight gain consistent with the guideline recommendations. Affordability will be evaluated using (iv) budget impact assessment and will estimate the financial implications of adoption and diffusion of this implementation strategy from the perspective of relevant fund-holders.
Together with the findings from the effectiveness trial, the outcomes of this economic evaluation will inform future healthcare policy, investment allocation, and research regarding the implementation of antenatal care to support healthy gestational weight gain.
Trial Registration: Australian and New Zealand Clinical Trials Registry, ACTRN12621000054819 (22/01/2021) http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380680&isReview=true .
产前临床实践指南建议对体重进行常规评估，并就孕期推荐的体重增加提供建议，以及在适当的时候转诊至其他服务机构。然而，临床医生在采用此类最佳实践指南时存在障碍。需要有效、具有成本效益且负担得起的实施策略，以确保实现指南的预期益处。本文描述了一项评估与公共产前服务中的常规做法相比，实施策略的效率和可负担性的方案。
基于前瞻性试验的经济评估将识别、衡量并评估与常规做法相比，实施策略所产生的关键资源和结果影响。该评估将包括：（i）成本核算；（ii）成本后果分析，其中将采用记分卡方法来展示鉴于试验中包含的多个主要结果所产生的成本和效益；以及（iii）成本效益分析，其中主要结果将是每增加一个百分点报告接受符合指南建议的孕期体重增加产前护理的参与者所产生的增量成本。将使用（iv）预算影响评估来评估可负担性，并将从相关资金持有者的角度估计采用和推广该实施策略的财务影响。
结合有效性试验的结果，这项经济评估的结果将为未来关于实施产前护理以支持健康孕期体重增加的医疗保健政策、投资分配和研究提供信息。
试验注册：澳大利亚和新西兰临床试验注册中心，ACTRN12621000054819（2021年1月22日）http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380680&isReview=true 。
