一种评估实施计划成本效益的协调方法：以提高硫酸镁在早产中使用率的质量改进计划为例

A Reconciled Method for Evaluating the Cost-Effectiveness of Implementation Programmes: Illustrated by Quality Improvement Programmes to Increase the Uptake of Magnesium Sulphate in Preterm Births.

作者信息

Sillero-Rejon Carlos, Hollingworth William, Opmeer Brent C, Luyt Karen, McLeod Hugh

机构信息

National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust. Whitefriars Level 9, Lewins Mead, Bristol, BS12NT, UK.

Health Economics and Health Policy @ Bristol, Population Health Sciences, University of Bristol, Bristol, BS8 1UD, UK.

出版信息

Appl Health Econ Health Policy. 2025 Aug 12. doi: 10.1007/s40258-025-00993-6.

DOI:10.1007/s40258-025-00993-6

PMID:40794240

Abstract

BACKGROUND

Methods for the economic evaluation of implementation initiatives to increase the uptake of cost-effective healthcare interventions are not standardised. Value of implementation and policy cost-effectiveness are two proposed approaches. This research aims to compare these two methods and propose a standardised approach. To illustrate this, we evaluated two implementation programmes to increase magnesium sulphate (MgSO) uptake in preterm labour to reduce the risk of cerebral palsy: (i) the National PReCePT Programme (NPP), which provided regional support and funded clinical time in maternity units in England, and (ii) an enhanced support programme (ESP) with additional unit-level coaching and extra funded time, which was nested within the NPP and subject to a cluster randomised control trial.

METHODS

After summarising value of implementation and policy cost-effectiveness methods, we explored the extent to which the two methods can be viewed as mathematically equivalent for the purpose of evaluating the NPP (versus pre-existing trends) and the ESP (versus the NPP) calculating their incremental cost-effectiveness ratios, net monetary benefits and their probability of being cost-effective.

RESULTS

We demonstrate how the value of implementation and policy cost-effectiveness approaches can be expressed in equivalent terms and set out our standardised stepwise method for evaluating the NPP (versus pre-existing trends) and the ESP (versus the NPP). Our method found that the NPP generated a net monetary benefit of £30,247 per maternity unit over 12 months, with a 98% probability of being cost-effective. In contrast, the ESP generated a net monetary loss of £28,682 per unit compared with the NPP, with a 22% probability of being cost-effective.

DISCUSSION

Our standardised method could promote a more systematic assessment of the value for money of implementation interventions.

摘要

背景

用于评估旨在提高具有成本效益的医疗保健干预措施采用率的实施举措的经济评估方法尚未标准化。实施价值和政策成本效益是两种提议的方法。本研究旨在比较这两种方法并提出一种标准化方法。为说明这一点，我们评估了两项旨在提高早产时硫酸镁（MgSO）使用率以降低脑瘫风险的实施计划：（i）国家早产预防与护理计划（NPP），该计划在英格兰为产科单位提供区域支持并资助临床时间；（ii）一项强化支持计划（ESP），提供额外的单位层面指导和额外资助时间，该计划嵌套在NPP内并进行了整群随机对照试验。

方法

在总结实施价值和政策成本效益方法后，我们探讨了为评估NPP（相对于先前趋势）和ESP（相对于NPP）计算其增量成本效益比、净货币效益及其具有成本效益的概率时，这两种方法在数学上可被视为等效的程度。

结果

我们展示了实施价值和政策成本效益方法如何能用等效术语表示，并阐述了我们用于评估NPP（相对于先前趋势）和ESP（相对于NPP）的标准化逐步方法。我们的方法发现，NPP在12个月内每个产科单位产生了30,247英镑的净货币效益，具有成本效益的概率为98%。相比之下，与NPP相比，ESP每个单位产生了28,682英镑的净货币损失，具有成本效益的概率为22%。