The value of implementation: how to invest in getting cost-effective technologies into practice. Framework and application to novel oral anticoagulants in the prevention of stroke and systemic embolism

TY - UNPB

T1 - The value of implementation: how to invest in getting cost-effective technologies into practice.

T2 - Framework and application to novel oral anticoagulants in the prevention of stroke and systemic embolism

AU - Faria, Rita

AU - Walker, Simon Mark

AU - Whyte, Sophie

AU - Dixon, Simon

AU - Palmer, Stephen John

AU - Sculpher, Mark

PY - 2015

Y1 - 2015

N2 - Despite being appraised as cost effective and recommended for use in a health system, some interventions are slow to be used. In such situations, a range of implementation activities may be considered to increase uptake. The value of these activities, which require funding by publicly-funded healthcare services, should be assessed in a manner consistent to that of other interventions that compete for funding from the same constrained budget. This study proposes a framework for the evaluation of the value of implementation interventions and applies it to the case study of novel oral anticoagulants (NOACs). It explores the potential of value of implementation analysis in informing decisions on how much to invest to increase utilisation, how best to target implementation efforts and explores the impact of uncertainties in the evidence-base. The results suggest that there is value in additional implementation activities, particularly in targeting patients with average or poor warfarin control. At a cost-effectiveness threshold of £20,000 per QALY gained, additional investment in an educational activity that increases utilisation by 5% in the entire population currently on warfarin generates additional 254 QALYs vs 973 QALYs in the subgroup with average to poor warfarin control. Most importantly, greater value to the NHS could be achieved with higher uptake of anticoagulation more generally: switching 5% of patients potentially eligible for anticoagulation but currently on no treatment or on aspirin would generate an additional 4,990 QALYs. This work has implications to how the NICE technology appraisal process could be improved to better help commissioners and clinicians implement guidance.

AB - Despite being appraised as cost effective and recommended for use in a health system, some interventions are slow to be used. In such situations, a range of implementation activities may be considered to increase uptake. The value of these activities, which require funding by publicly-funded healthcare services, should be assessed in a manner consistent to that of other interventions that compete for funding from the same constrained budget. This study proposes a framework for the evaluation of the value of implementation interventions and applies it to the case study of novel oral anticoagulants (NOACs). It explores the potential of value of implementation analysis in informing decisions on how much to invest to increase utilisation, how best to target implementation efforts and explores the impact of uncertainties in the evidence-base. The results suggest that there is value in additional implementation activities, particularly in targeting patients with average or poor warfarin control. At a cost-effectiveness threshold of £20,000 per QALY gained, additional investment in an educational activity that increases utilisation by 5% in the entire population currently on warfarin generates additional 254 QALYs vs 973 QALYs in the subgroup with average to poor warfarin control. Most importantly, greater value to the NHS could be achieved with higher uptake of anticoagulation more generally: switching 5% of patients potentially eligible for anticoagulation but currently on no treatment or on aspirin would generate an additional 4,990 QALYs. This work has implications to how the NICE technology appraisal process could be improved to better help commissioners and clinicians implement guidance.

M3 - Working paper

BT - The value of implementation: how to invest in getting cost-effective technologies into practice.

ER -