Theory and practice: Finding common ground between health economics and implementation science

Wensing-Michel-1-239x300 18.1Can health economics and the practical realities of delivering healthcare work side by side? Michel Wensing, professor of implementation science at Radboud University Medical Centre, Nijmegen, Netherlands, and co-editor-in-chief of Implementation Science considers a new editorial on this question.

Many health professionals and health researchers have little interest in the costs of healthcare, perhaps with the exception of their personal reimbursement. Published economic studies have little relevance for them.

And, in fact, they may be correct. Economic analyses in healthcare are often designed to support decision-making on the reimbursement of treatments, devices and programs in national healthcare systems. Therefore a societal perspective and long-term time horizon are taken, non-healthcare costs are included, and non-clinical utilities are preferred as outcomes. Such economic studies have indeed little relevance for many decisions and practices in daily healthcare practice, management, or policy.

Nevertheless, I think that health economics and health technology assessment provide an interesting toolbox of concepts and methods. These are useful for implementation science, particularly if used with some flexibility and imagination.

Implementation of evidence-based recommendations and clinical outcomes are often perceived as more relevant than utilities (global values attached to health states), which are the preferred outcomes in health economics. In addition, it is often informative for decision-makers to provide an economic analysis that focuses on short-term consequences for a specific healthcare provider. For instance, a primary care provider may save overall healthcare costs by implementing some recommended practice, but not actually receive the financial savings.

Economic analysis is much broader than cost-effectiveness studies, which provide the famous incremental cost-effectiveness ratio (ICER). Economic methods such as Data Envelopment Analysis can be used to assess the efficiency of providers in providing evidence-based care, and help to identify determinants of efficient practice. Likewise, managers and policy makers can use economic concepts and methods to guide their decisions.

Implementation of economic analyses in implementation science remains a challenge. The editorial by Hoomans and Severens in Implementation Science provides an overview of the methods and an exploration of the barriers for their implementation in health research.

My experience as researcher suggests that most clinicians realize that taking part in implementation programs may imply substantial time investments for them. However, if they agree with the principle that the outcomes of such programs need to be evaluated, it takes only one more step to accept these outcomes need to be balanced with the invested time. In addition, many clinicians and managers understand very well where financial savings are realized, particularly if this is not in their organization.

So, I believe that it is possible for health economists and implementation scientists to find common ground. Hopefully the editorial by Hoomans and Severens will contribute to this.

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