Economic evaluations of audit and feedback interventions: a systematic review

Lynne Moore; Jason Robert Guertin; Pier-Alexandre Tardif; Noah Michael Ivers; Jeffrey Hoch; Blanchard Conombo; Jesmin Antony; Henry Thomas Stelfox; Simon Berthelot; Patrick Archambault; Alexis Turgeon; Rohit Gandhi; J M Grimshaw

doi:10.1136/bmjqs-2022-014727

Economic evaluations of audit and feedback interventions: a systematic review

BMJ Qual Saf. 2022 Oct;31(10):754-767. doi: 10.1136/bmjqs-2022-014727. Epub 2022 Jun 24.

Affiliations

¹ Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Quebec, Canada lynne.moore@fmed.ulaval.ca.
² Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Quebec, Canada.
³ Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
⁴ Department of Public Health Sciences, University of California San Francisco, San Francisco, California, USA.
⁵ Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada.
⁶ Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada.
⁷ Department of Pediatric Neurology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
⁸ Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

PMID: 35750494
DOI: 10.1136/bmjqs-2022-014727

Abstract

Background: The effectiveness of audit and feedback (A&F) interventions to improve compliance to healthcare guidelines is supported by randomised controlled trials (RCTs) and meta-analyses of RCTs. However, there is currently a knowledge gap on their cost-effectiveness.

Objective: We aimed to assess whether A&F interventions targeting improvements in compliance to recommended care are economically favourable.

Methods: We conducted a systematic review including experimental, observational and simulation-based economic evaluation studies of A&F interventions targeting healthcare providers. Comparators were a 'do nothing' strategy, or any other intervention not involving A&F or involving a subset of A&F intervention components. We searched MEDLINE, CINAHL, CENTRAL, Econlit, EMBASE, Health Technology Assessment Database, MEDLINE, NHS Economic Evaluation Database, ABI/INFORM, Web of Science, ProQuest and websites of healthcare quality associations to December 2021. Outcomes were incremental cost-effectiveness ratios, incremental cost-utility ratios, incremental net benefit and incremental cost-benefit ratios. Pairs of reviewers independently selected eligible studies and extracted relevant data. Reporting quality was evaluated using CHEERS (Consolidated Health Economic Evaluation Reporting Standards). Results were synthesised using permutation matrices for all studies and predefined subgroups.

Results: Of 13 221 unique citations, 35 studies met our inclusion criteria. The A&F intervention was dominant (ie, at least as effective with lower cost) in 7 studies, potentially cost-effective in 26 and was dominated (ie, the same or less effectiveness and higher costs) in 2 studies. A&F interventions were more likely to be economically favourable in studies based on health outcomes rather than compliance to recommended practice, considering medical costs in addition to intervention costs, published since 2010, and with high reporting quality.

Discussion: Results suggest that A&F interventions may have a high potential to be cost-effective. However, as is common in systematic reviews of economic evaluations, publication bias could have led to an overestimation of their economic value.

Keywords: Audit and feedback; Cost-effectiveness; Healthcare quality improvement.

Publication types

Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Cost-Benefit Analysis
Delivery of Health Care*
Feedback
Health Personnel*
Humans