The value of implementation and the value of information: combined and uneven development

Fenwick, E., Claxton, K. and Sculpher, M. (2008) The value of implementation and the value of information: combined and uneven development. Medical Decision Making, 28(1), pp. 21-32. (doi: 10.1177/0272989X07308751)

Abstract

<i>Aim</i>: In a budget-constrained health care system, the decision to invest in strategies to improve the implementation of cost-effective technologies must be made alongside decisions regarding investment in the technologies themselves and investment in further research. This article presents a single, unified framework that simultaneously addresses the problem of allocating funds between these separate but linked activities. <i>Methods</i>: The framework presents a simple 4-state world where both information and implementation can be either at the current level or "perfect". Through this framework, it is possible to determine the maximum return to further research and an upper bound on the value of adopting implementation strategies. The framework is illustrated through case studies of health care technologies selected from those previously considered by the UK National Institute for Health and Clinical Excellence (NICE). <i>Results</i>: Through the case studies, several key factors that influence the expected values of perfect information and perfect implementation are identified. These factors include the maximum acceptable cost-effectiveness ratio, the level of uncertainty surrounding the adoption decision, the expected net benefits associated with the technologies, the current level of implementation, and the size of the eligible population. <i>Conclusions</i>: Previous methods for valuing implementation strategies have not distinguished the value of efficacy research and the value of strategies to change the level of implementation. This framework demonstrates that the value of information and the value of implementation can be examined separately but simultaneously in a single framework. This can usefully inform policy decisions about investment in health care services, further research, and adopting implementation strategies that are likely to differ between technologies.

• Item Type: Articles
• Keywords: Value of information analysis, value of implementation, health care decision making, Bayesian analysis.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Fenwick, Professor Elisabeth
• Authors: Fenwick, E., Claxton, K., and Sculpher, M.
• Subjects: R Medicine > RA Public aspects of medicine; H Social Sciences > HJ Public Finance
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Centre for Population and Health Sciences
• Journal Name: Medical Decision Making
• Journal Abbr.: Med. decis. mak.
• Publisher: SAGE
• ISSN: 0272-989X
• ISSN (Online): 1552-681X
• Copyright Holders: Copyright © 2008 Sage
• First Published: First published in Medical Decision Making 28(1):21-32
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher.