Economic evaluation can inform whether strategies designed to improve the quality of health care delivery and the uptake of evidence-based practices represent a cost-effective use of limited resources. We report a systematic review and critical appraisal of the application of health economic methods in improvement/implementation research. A systematic literature search identified 1668 papers across the Agris, Embase, Global Health, HMIC, PsycINFO, Social Policy and Practice, MEDLINE and EconLit databases between 2004 and 2016. Abstracts were screened in Rayyan database, and key data extracted into Microsoft Excel. Evidence was critically appraised using the Quality of Health Economic Studies (QHES) framework. Thirty studies were included—all health economic studies that included implementation or improvement as a part of the evaluation. Studies were conducted mostly in Europe (62%) or North America (23%) and were largely hospital-based (70%). The field was split between improvement (N = 16) and implementation (N = 14) studies. The most common intervention evaluated (43%) was staffing reconfiguration, specifically changing from physician-led to nurse-led care delivery. Most studies (N = 19) were ex-post economic evaluations carried out empirically—of those, 17 were cost effectiveness analyses. We found four cost utility analyses that used economic modelling rather than empirical methods. Two cost-consequence analyses were also found. Specific implementation costs considered included costs associated with staff training in new care delivery pathways, the impacts of new processes on patient and carer costs and the costs of developing new care processes/pathways. Over half (55%) of the included studies were rated ‘good’ on QHES. Study quality was boosted through inclusion of appropriate comparators and reporting of incremental analysis (where relevant); and diminished through use of post-hoc subgroup analysis, limited reporting of the handling of uncertainty and justification for choice of discount rates. The quantity of published economic evaluations applied to the field of improvement and implementation research remains modest; however, quality is overall good. Implementation and improvement scientists should work closely with health economists to consider costs associated with improvement interventions and their associated implementation strategies. We offer a set of concrete recommendations to facilitate this endeavour.

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卫生经济评估在实施和改进科学领域中的应用-系统的文献综述

经济评估可以说明旨在提高卫生保健质量和采用循证实践的策略是否代表对有限资源的成本有效使用。我们报告了对健康经济方法在改善/实施研究中的应用的系统评价和严格评估。通过系统的文献检索，在2004年至2016年之间，在Agris，Embase，Global Health，HMIC，PsycINFO，社会政策与实践，MEDLINE和EconLit数据库中确定了1668篇论文。摘要在Rayyan数据库中进行了筛选，并将关键数据提取到了Microsoft Excel中。证据使用卫生经济学研究质量（QHES）框架进行了严格评估。包括30项研究-所有健康经济研究，其中包括实施或改进作为评估的一部分。研究主要在欧洲（62％）或北美（23％）进行，并且大部分以医院为基础（70％）。该领域分为改进研究（N = 16）和实施研究（N = 14）。评估的最常见干预措施（43％）是人员配置，特别是从医生主导转向由护士主导的护理提供。大多数研究（N = 19）是根据经验进行的事后经济评估，其中有17项是成本效益分析。我们发现了四种成本效用分析，它们使用经济模型而非经验方法。还发现了两个成本后果分析。考虑的具体实施成本包括与在新护理提供途径中的员工培训相关的费用，新流程对患者和护理人员成本的影响以及开发新护理流程/途径的成本。超过一半（55％）的纳入研究在QHES上被评为“良好”。通过包括适当的比较器和报告增量分析（在相关情况下），提高了研究质量；并通过事后分组分析，有限不确定性处理报告和选择折现率的合理性减少了报告的数量。适用于改进和实施研究领域的已发布经济评估数量仍然很少；但是，质量总体上是好的。实施和改善科学家应与卫生经济学家密切合作，以考虑与改善干预措施及其相关实施策略相关的成本。我们提供了一系列具体建议来促进这一努力。通过包括适当的比较器和报告增量分析（在相关情况下），提高了研究质量；并通过事后分组分析，有限不确定性处理报告和选择折现率的合理性减少了报告的数量。适用于改进和实施研究领域的已发布经济评估数量仍然很少；但是，质量总体上是好的。实施和改善科学家应与卫生经济学家密切合作，以考虑与改善干预措施及其相关实施策略相关的成本。我们提供了一系列具体建议来促进这一努力。通过包括适当的比较器和报告增量分析（在相关情况下），提高了研究质量；并通过事后分组分析，有限不确定性处理报告和选择折现率的合理性减少了报告的数量。适用于改进和实施研究领域的已发布经济评估数量仍然很少；但是，质量总体上是好的。实施和改善科学家应与卫生经济学家密切合作，以考虑与改善干预措施及其相关实施策略相关的成本。我们提供了一系列具体建议来促进这一努力。关于折现率选择的不确定性和合理性处理的报道有限。适用于改进和实施研究领域的已发布经济评估数量仍然很少；但是，质量总体上是好的。实施和改善科学家应与卫生经济学家密切合作，以考虑与改善干预措施及其相关实施策略相关的成本。我们提供了一系列具体建议来促进这一努力。关于折现率选择的不确定性和合理性处理的报道有限。适用于改进和实施研究领域的已发布经济评估数量仍然很少；但是，质量总体上是好的。实施和改善科学家应与卫生经济学家密切合作，以考虑与改善干预措施及其相关实施策略相关的成本。我们提供了一系列具体建议来促进这一努力。实施和改善科学家应与卫生经济学家密切合作，以考虑与改善干预措施及其相关实施策略相关的成本。我们提供了一系列具体建议来促进这一努力。实施和改善科学家应与卫生经济学家密切合作，以考虑与改善干预措施及其相关实施策略相关的成本。我们提供了一系列具体建议来促进这一努力。