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Article Title

The Role of Cost Information in Health System Decisions to Adopt New Services

Publication Date

4-30-2015

Keywords

cost-effectiveness, implementation

Abstract

Background/Aims: Health systems are under increasing pressure to make careful choices about which new services to adopt or encourage for their populations. At the same time, explicit use of information on cost-effectiveness of interventions in the decision process is controversial in the United States. Yet health system decision-makers routinely need to make decisions about what types of interventions to adopt or promote within a limited budget. Economic evaluations such as cost-effectiveness analyses are one source of information that could potentially aid health system decision-makers in evaluating interventions. Yet little is known about how useful typical published economic evaluations are to health system decision-makers, or whether or not they provide the type of information most useful in the decision process.

Methods: We conducted in-depth qualitative interviews by telephone with a purposive sample of 38 public and private health system decision-makers. We discussed decision-making in general, type of information used in the process and the usefulness of cost information. All transcripts were coded by trained coders and entered into Atlas.ti, which was used to code and manage data and to generate reports for analysis. The team reviewed reports and engaged in an iterative process of discussion and review, resulting in the final themes. We also looked at results by size of organization and type of service under evaluation (medical or mental health).

Results: Participants reported a variety of internal and external factors perceived to influence adoption to their organizations. The two most highly endorsed factors were clinical effectiveness and financial feasibility. Other highly endorsed factors included ease of integration into current practice and provider/staff acceptability. Most participants reported wanting information on direct costs of an intervention, and about half of the participants wanted published cost-effectiveness information. Participants reported differences in decision-making between medical and mental health interventions, for example, several participants suggested that mental health interventions were more difficult to evaluate both in terms of effectiveness and cost compared to medical interventions.

Discussion: Cost information is important to all the organizations and decision-makers we interviewed. However, typical published economic evaluations may not contain some of the cost information needed by decision-makers.

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