The economics of adaptations to evidence-based practices

Ramzi G Salloum; Todd H Wagner; Amanda M Midboe; Sarah I Daniels; Andrew Quanbeck; David A Chambers

doi:10.1186/s43058-022-00345-8

The economics of adaptations to evidence-based practices

Implement Sci Commun. 2022 Sep 24;3(1):100. doi: 10.1186/s43058-022-00345-8.

Authors

Ramzi G Salloum¹, Todd H Wagner^{2

3}, Amanda M Midboe⁴, Sarah I Daniels⁴, Andrew Quanbeck⁵, David A Chambers⁶

Affiliations

¹ Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Room 2243, Gainesville, FL, 32610, USA. rsalloum@ufl.edu.
² Palo Alto Health Economics Research Center, Department of Veterans Affairs, Menlo Park, CA, USA.
³ Department of Surgery, School of Medicine, Stanford University, Stanford, CA, USA.
⁴ Center for Innovation to Implementation, Palo Alto Health Care System, Department of Veterans Affairs, Menlo Park, CA, USA.
⁵ Department of Family Medicine and Community Health, School of Medicine, University of Wisconsin, Madison, WI, USA.
⁶ Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.

Abstract

Background: Evidence-based practices (EBPs) are frequently adapted in response to the dynamic contexts in which they are implemented. Adaptation is defined as the degree to which an EBP is altered to fit the setting or to improve fit to local context and can be planned or unplanned. Although adaptations are common and necessary to maximizing the marginal impact of EBPs, little attention has been given to the economic consequences and how adaptations affect marginal costs.

Discussion: In assessing the economic consequences of adaptation, one should consider its impact on core components, the planned adaptive periphery, and the unplanned adaptive periphery. Guided by implementation science frameworks, we examine how various economic evaluation approaches accommodate the influence of adaptations and discuss the pros and cons of these approaches. Using the Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME), mixed methods can elucidate the economic reasons driving the adaptations. Micro-costing approaches are applied in research that integrates the adaptation of EBPs at the planning stage using innovative, adaptive study designs. In contrast, evaluation of unplanned adaptation is subject to confounding and requires sensitivity analysis to address unobservable measures and other uncertainties. A case study is presented using the RE-AIM framework to illustrate the costing of adaptations. In addition to empirical approaches to evaluating adaptation, simulation modeling approaches can be used to overcome limited follow-up in implementation studies.

Conclusions: As implementation science evolves to improve our understanding of the mechanisms and implications of adaptations, it is increasingly important to understand the economic implications of such adaptations, in addition to their impact on clinical effectiveness. Therefore, explicit consideration is warranted of how costs can be evaluated as outcomes of adaptations to the delivery of EBPs.

Keywords: Adaptation; Adaptive; Cost; Economic evaluation; Economics.

Grants and funding

UL1TR001427/TR/NCATS NIH HHS/United States