Background

Studies have been published regarding the impact of major system change (MSC) on care quality and outcomes, but few evaluate implementation costs or include them in cost-effectiveness analysis (CEA). This is despite large potential costs of MSC: change planning, purchasing or repurposing assets, and staff time. Implementation costs can influence implementation decisions. We describe our framework and principles for costing MSC implementation and illustrate them using a case study.

Methods

We outlined MSC implementation stages and identified components, using a framework conceived during our work on MSC in stroke services. We present a case study of MSC of specialist surgery services for prostate, bladder, renal and oesophagogastric cancers, focusing on North Central and North East London and West Essex. Health economists collaborated with qualitative researchers, clinicians and managers, identifying key reconfiguration stages and expenditures. Data sources (n = approximately 100) included meeting minutes, interviews, and business cases. National Health Service (NHS) finance and service managers and clinicians were consulted. Using bottom-up costing, items were identified, and unit costs based on salaries, asset costs and consultancy fees assigned. Itemised costs were adjusted and summed.

Results

Cost components included options appraisal, bidding process, external review; stakeholder engagement events; planning/monitoring boards/meetings; and making the change: new assets, facilities, posts. Other considerations included hospital tariff changes; costs to patients; patient population; and lifetime of changes. Using the framework facilitated data identification and collection. The total adjusted implementation cost was estimated at £7.2 million, broken down as replacing robots (£4.0 million), consultancy fees (£1.9 million), staff time costs (£1.1 million) and other costs (£0.2 million).

Conclusions

These principles can be used by funders, service providers and commissioners planning MSC and researchers evaluating MSC. Health economists should be involved early, alongside qualitative and health-service colleagues, as retrospective capture risks information loss. These analyses are challenging; many cost factors are difficult to identify, access and measure, and assumptions regarding lifetime of the changes are important. Including implementation costs in CEA might make MSC appear less cost effective, influencing future decisions. Future work will incorporate this implementation cost into the full CEAs of the London Cancer MSC.

Trial Registration

Not applicable.

中文翻译：

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如何为经济评估的重大系统变革实施成本：在英国伦敦部分地区使用专科癌症手术重新配置的案例研究

背景

有关重大系统变革 (MSC) 对护理质量和结果的影响的研究已经发表，但很少有人评估实施成本或将其纳入成本效益分析 (CEA)。尽管 MSC 有巨大的潜在成本：变更计划、购买或重新利用资产以及员工时间，但仍然如此。实施成本会影响实施决策。我们描述了计算 MSC 实施成本的框架和原则，并使用案例研究对其进行了说明。

方法

我们使用我们在卒中服务中的 MSC 工作期间构想的框架概述了 MSC 实施阶段并确定了组件。我们介绍了针对前列腺癌、膀胱癌、肾癌和食道胃癌的专科手术服务的 MSC 案例研究，重点关注伦敦中北部和东北部以及西埃塞克斯。健康经济学家与定性研究人员、临床医生和管理人员合作，确定关键的重组阶段和支出。数据源（n = 大约 100）包括会议记录、访谈和商业案例。咨询了国民健康服务 (NHS) 的财务和服务经理以及临床医生。使用自下而上的成本核算，确定项目，并根据工资、资产成本和咨询费分配单位成本。对分项成本进行了调整和汇总。

结果

成本构成包括期权评估、投标过程、外部审查；利益相关者参与活动；计划/监督委员会/会议；并做出改变：新资产、设施、职位。其他考虑因素包括医院收费的变化；患者的费用；患者人群；和变化的生命周期。使用该框架有助于数据识别和收集。调整后的实施总成本估计为 720 万英镑，细分为更换机器人（400 万英镑）、咨询费（190 万英镑）、员工时间成本（110 万英镑）和其他成本（20 万英镑）。

结论

这些原则可供计划 MSC 的资助者、服务提供商和专员以及评估 MSC 的研究人员使用。卫生经济学家应与定性和卫生服务同事一起尽早参与，因为回顾性捕获存在信息丢失的风险。这些分析具有挑战性；许多成本因素难以识别、获取和衡量，而关于变更生命周期的假设很重要。在 CEA 中包含实施成本可能会降低 MSC 的成本效益，从而影响未来的决策。未来的工作将把这个实施成本纳入伦敦癌症 MSC 的完整 CEA。

试用注册

不适用。