Finnish Coordinating Center for Health Technology Assessment, Oulu University Hospital, University of Oulu, Oulu, Finland.
Finnish Medical Society Duodecim, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Implement Sci. 2023 Aug 21;18(1):36. doi: 10.1186/s13012-023-01290-3.
De-implementation of low-value care can increase health care sustainability. We evaluated the reporting of direct costs of de-implementation and subsequent change (increase or decrease) in health care costs in randomized trials of de-implementation research.
We searched MEDLINE and Scopus databases without any language restrictions up to May 2021. We conducted study screening and data extraction independently and in duplicate. We extracted information related to study characteristics, types and characteristics of interventions, de-implementation costs, and impacts on health care costs. We assessed risk of bias using a modified Cochrane risk-of-bias tool.
We screened 10,733 articles, with 227 studies meeting the inclusion criteria, of which 50 included information on direct cost of de-implementation or impact of de-implementation on health care costs. Studies were mostly conducted in North America (36%) or Europe (32%) and in the primary care context (70%). The most common practice of interest was reduction in the use of antibiotics or other medications (74%). Most studies used education strategies (meetings, materials) (64%). Studies used either a single strategy (52%) or were multifaceted (48%). Of the 227 eligible studies, 18 (8%) reported on direct costs of the used de-implementation strategy; of which, 13 reported total costs, and 12 reported per unit costs (7 reported both). The costs of de-implementation strategies varied considerably. Of the 227 eligible studies, 43 (19%) reported on impact of de-implementation on health care costs. Health care costs decreased in 27 studies (63%), increased in 2 (5%), and were unchanged in 14 (33%).
De-implementation randomized controlled trials typically did not report direct costs of the de-implementation strategies (92%) or the impacts of de-implementation on health care costs (81%). Lack of cost information may limit the value of de-implementation trials to decision-makers.
OSF (Open Science Framework): https://osf.io/ueq32 .
减少低价值医疗可以提高医疗保健的可持续性。我们评估了随机实施减少低价值医疗试验中减少低价值医疗的直接成本报告以及随后对医疗成本的变化（增加或减少）。
我们在 2021 年 5 月之前，在 MEDLINE 和 Scopus 数据库中进行了无语言限制的搜索。我们独立地进行了两次研究筛选和数据提取。我们提取了与研究特征、干预类型和特征、减少低价值医疗的成本以及对医疗成本的影响相关的信息。我们使用改良的 Cochrane 偏倚风险工具评估了偏倚风险。
我们筛选了 10733 篇文章，其中 227 篇研究符合纳入标准，其中 50 篇研究包含了减少低价值医疗的直接成本或减少低价值医疗对医疗成本的影响的信息。研究主要在北美（36%）或欧洲（32%）和初级保健环境中进行（70%）。最常见的关注实践是减少抗生素或其他药物的使用（74%）。大多数研究使用了教育策略（会议、材料）（64%）。研究使用了单一策略（52%）或多方面策略（48%）。在 227 项合格研究中，18 项（8%）报告了所使用的减少低价值医疗策略的直接成本；其中 13 项报告了总成本，12 项报告了单位成本（7 项同时报告了两者）。减少低价值医疗策略的成本差异很大。在 227 项合格研究中，43 项（19%）报告了减少低价值医疗对医疗成本的影响。27 项研究（63%）的医疗成本降低，2 项研究（5%）的医疗成本增加，14 项研究（33%）的医疗成本不变。
减少低价值医疗的随机对照试验通常没有报告减少低价值医疗策略的直接成本（92%）或减少低价值医疗对医疗成本的影响（81%）。缺乏成本信息可能会限制减少低价值医疗试验对决策者的价值。
OSF（开放科学框架）：https://osf.io/ueq32 。
