Economic Evaluation of Active Implementation versus Guideline Dissemination for Evidence-Based Care of Acute Low-Back Pain in a General Practice Setting
Open accessAbstract
INTRODUCTION: The development and publication of clinical practice guidelines for acute low-back pain has resulted in evidence-based recommendations that have the potential to improve the quality and safety of care for acute low-back pain. Development and dissemination of guidelines may not, however, be sufficient to produce improvements in clinical practice; further investment in active implementation of guideline recommendations may be required. Further research is required to quantify the trade-off between the additional upfront cost of active implementation of guideline recommendations for low-back pain and any resulting improvements in clinical practice. METHODS: Cost-effectiveness analysis alongside the IMPLEMENT trial from a health sector perspective to compare active implementation of guideline recommendations via the IMPLEMENT intervention (plus standard dissemination) against standard dissemination alone. RESULTS: The base-case analysis suggests that delivery of the IMPLEMENT intervention dominates standard dissemination (less costly and more effective), yielding savings of $135 per x-ray referral avoided (-$462.93/3.43). However, confidence intervals around point estimates for the primary outcome suggest that--irrespective of willingness to pay (WTP)--we cannot be at least 95% confident that the IMPLEMENT intervention differs in value from standard dissemination. CONCLUSIONS: Our findings demonstrate that moving beyond development and dissemination to active implementation entails a significant additional upfront investment that may not be offset by health gains and/or reductions in health service utilization of sufficient magnitude to render active implementation cost-effective.
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Nineteen studies were ex-post economic evaluations; of those, 17 were cost-effectiveness analyses.
“Nineteen studies were ex-post economic evaluations of which 17 were CEAs with one CUA [7, 12, 14, 15, 17] [18–30, 33].”
From Use of health economic evaluation in the implementation and improvement science fields—a systematic literature review (2019) · cites this paper as [22]
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Self-citation
- Authors
- Mortimer, D., French, S. D., McKenzie, J. E., O′Connor, D. A., & Green, S. E.
- Affiliations
- Monash University (AU)
- The University of Melbourne (AU)
- Corresponding author
- Mortimer, Duncan
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2013-10-11
- Volume
- 8
- Issue
- 10
- Pages
- e75647
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3795707
- OpenAlex
- W1977128121
- Cited by
- 30
- References
- 26
- Citations by year
- 2026: 3 · 2024: 2 · 2023: 1 · 2022: 7 · 2021: 1 · 2020: 5 · 2019: 3 · 2018: 1 · 2017: 2 · 2016: 2 · 2015: 2 · 2014: 1
- FWCI
- 1.70
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- Medical Research Council
- National Health and Medical Research Council (334060)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- acute low back pain, guideline implementation, guideline dissemination, cost-effectiveness, general practice, health care utilization, evidence-based care
- MeSH terms
- Australia, Cost-Benefit Analysis, Humans, Radiography, Referral and Consultation, Low Back Pain, Practice Guidelines as Topic, General Practice
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