Journal Article

Reporting of costs and economic impacts in randomized trials of de-implementation interventions for low-value care: a systematic scoping review

Miia Turpeinen, Herney A. Garcia-Perdomo, Marco H. Blanker, Olli Lainiala, Aleksi J. Raudasoja, Jussi M. J. Mustonen, Rufus Cartwright, Raija Sipilä, Petra Falkenbach, Tiina Lamberg, Tuomas P. Kilpeläinen, Patrick O. Richard, Arnav Agarwal, Kari A. O. Tikkinen, Jorma Komulainen, Philippe D. Violette, Eero Raittio, Robin W. M. Vernooij, Yoshitaka Aoki, Olli P. O. Nevalainen

2023

Overview

Background De-implementation of low-value care can increase health care sustainability. We evaluated the reporting of direct costs of de-implementation and subsequent change (increase or decrease) in health care costs in randomized trials of de-implementation research. Methods We searched MEDLINE and Scopus databases without any language restrictions up to May 2021. We conducted study screening and data extraction independently and in duplicate. We extracted information related to study characteristics, types and characteristics of interventions, de-implementation costs, and impacts on health care costs. We assessed risk of bias using a modified Cochrane risk-of-bias tool. Results We screened 10,733 articles, with 227 studies meeting the inclusion criteria, of which 50 included information on direct cost of de-implementation or impact of de-implementation on health care costs. Studies were mostly conducted in North America (36%) or Europe (32%) and in the primary care context (70%). The most common practice of interest was reduction in the use of antibiotics or other medications (74%). Most studies used education strategies (meetings, materials) (64%). Studies used either a single strategy (52%) or were multifaceted (48%). Of the 227 eligible studies, 18 (8%) reported on direct costs of the used de-implementation strategy; of which, 13 reported total costs, and 12 reported per unit costs (7 reported both). The costs of de-implementation strategies varied considerably. Of the 227 eligible studies, 43 (19%) reported on impact of de-implementation on health care costs. Health care costs decreased in 27 studies (63%), increased in 2 (5%), and were unchanged in 14 (33%). Conclusion De-implementation randomized controlled trials typically did not report direct costs of the de-implementation strategies (92%) or the impacts of de-implementation on health care costs (81%). Lack of cost information may limit the value of de-implementation trials to decision-makers. Trial registration OSF (Open Science Framework): https://osf.io/ueq32 .

• Publisher: Springer Science and Business Media LLC,BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: 3126 Surgery / 3126 Surgery, anesthesiology, intensive care, radiology / 3142 Public health care science / 3142 Public health care science, environmental and occupational health / 511 Economics / 517 Political science / Analysis / anesthesiology / Anti-Bacterial Agents / Antibiotics / Clinical medicine / Cost / Cost control / Databases, Factual / De-implementation / De-implementation strategy / Discrimination in medical care / Economic aspects / environmental and occupational health / Health Administration / Health aspects / Health Care Costs / Health care expenditures / Health care rationing / Health care science / Health Informatics / Health Policy / Health Promotion and Disease Prevention / Health Services Research / Humans / intensive care / Intervention / Low-Value Care / Medical care, Cost of / Medical practices / Medicine / Medicine & Public Health / Medicine (General) / Methods / Prevention / Public Health / R5-920 / radiology / Randomized Controlled Trials as Topic / Sustainable development / Systematic Review / Systematic scoping review