Cost analysis in implementation studies of evidence-based practices for mental health and substance use disorders: a systematic review

Implementation Science

Kathryn E. McCollister¹  Diana M. Bowser²  Brandy F. Henry³ 

[1] Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., CRB 1019, 33136, Miami, FL, USA;Heller School for Social Policy and Management, Brandeis University, 415 South St, 02453, Waltham, MA, USA;Heller School for Social Policy and Management, Brandeis University, 415 South St, 02453, Waltham, MA, USA;School of Social Work, Columbia University, 1255 Amsterdam Ave, 10027, New York, NY, USA;

关键词: Economics;    Costs;    Implementation;    Evidence-based practices;    Behavioral health;   

DOI  :  10.1186/s13012-021-01094-3

来源: Springer

【 摘 要 】

BackgroundThis study is a systematic literature review of cost analyses conducted within implementation studies on behavioral health services. Cost analysis of implementing evidence-based practices (EBP) has become important within implementation science and is critical for bridging the research to practice gap to improve access to quality healthcare services. Costing studies in this area are rare but necessary since cost can be a barrier to implementation and sustainment of EBP.MethodsWe followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology and applied the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Key search terms included: (1) economics, (2) implementation, (3) EBP, and (4) behavioral health. Terms were searched within article title and abstracts in: EconLit, SocINDEX, Medline, and PsychINFO. A total of 464 abstracts were screened independently by two authors and reduced to 37 articles using inclusion and exclusion criteria. After a full-text review, 18 articles were included.ResultsFindings were used to classify costs into direct implementation, direct services, and indirect implementation. While all studies included phases of implementation as part of their design, only five studies examined resources across multiple phases of an implementation framework. Most studies reported direct service costs associated with adopting a new practice, usually summarized as total EBP cost, cost per client, cost per clinician, and/or cost per agency. For studies with detailed analysis, there were eleven direct cost categories represented. For five studies that reported costs per child served, direct implementation costs varied from $886 to $9470 per child, while indirect implementation costs ranged from $897 to $3805 per child.ConclusionsThis is the first systematic literature review to examine costs of implementing EBP in behavioral healthcare settings. Since 2000, 18 studies were identified that included a cost analysis. Given a wide variation in the study designs and economic methods, comparison across studies was challenging, which is a major limitation in the field, as it becomes difficult to replicate studies or to estimate future costs to inform policy decisions related to budgeting. We recommend future economic implementation studies to consider standard economic costing methods capturing costs across implementation framework phases to support comparisons and replicability.

【 授权许可】

CC BY