Getting cost-effectiveness technologies into practice: the value of implementation

Getting cost-effective health technologies into practice is one of the priorities for the NHS identified in Innovation, Health and Wealth. There are a number of organisations and a wide range of policies aimed at promoting uptake of technologies by the NHS, however, there is little evidence around these and there do not appear to be plans to appraise their effectiveness.

There is a large body of evidence around the effectiveness of non-financial and financial implementation initiatives, but it is difficult to draw firm conclusions and the applicability of the findings to the NHS setting is unclear. The evidence on the cost-effectiveness of implementation strategies is very patchy and it is unclear on whether the results found are generalisable. There is data available on the diffusion of health technologies in the UK without implementation initiatives, however, the nature and length of the available time series and their heterogeneity suggest that a meta-analysis of all diffusion curves may not be sensible. Generating plausible diffusion scenarios from the present data instead appears to be the best way forward.

A number of frameworks exist for assessing the cost-effectiveness of implementation initiatives.

Although subtle differences exist between them, the general principles are consistent across frameworks. The cost-effectiveness of an implementation strategy is dependent not only on the effects and costs of the implementation strategy but also the effects and costs of the health care intervention.

A number of important factors in determining cost-effectiveness were identified including, for example, the rate of utilisation without an implementation strategy or the size of the patient population.