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. 2026 Jul 4;26:175. doi: 10.1186/s12874-026-02933-x

Integrating health economics and implementation science: a call to action

Lane Meredith 1, Helen Skouteris 2,3, Sarah Alderson 4, Mamta Bajre 5, Ruth E Barker 6, Paul Bird 7,8, Caroline S Clarke 9, Graeme Currie 3, Robbie Foy 10, Samuel Frempong 11, Clare Glover-Wright 12, Robert Heggie 13, Agnieszka Latuszynska 3, Hugh McLeod 14,15, Seyran Naghdi 16, Siyabonga Ndwandwe 9, Emily Rowe 3, Carlos Sillero-Rejon 14,15, Sophie Staniszewska 17, Michael Sykes 18, Davide Tebaldi 19, Mehdi Yousefi 20, Mandana Zanganeh 16, Amy L Grove 20,✉,#, Alisa M Higgins 1,#
PMCID: PMC13466652  PMID: 42401822

Abstract

Background

Health economics and implementation science play a critical role in the uptake of evidence-based practice but have largely sat siloed.

Methods

This paper summarises findings from a 3-day workshop on health economics and implementation science. Workshop attendees included 30 health economists, implementation scientists, patient contributors, and patient and public involvement and engagement researchers from Australia and the United Kingdom. A shared vision for moving from siloed to synergistic disciplinary approaches was derived through consensus.

Results

This article outlines to researchers and methodologists what synergistic disciplinary approaches could look like. We highlight opportunities for health economics and implementation science to integrate along the innovation pathway, from the development and evaluation of innovation to eventual uptake and spread.

Conclusions

Greater collaboration between implementation scientists and health economists has the potential to optimise implementation strategies, provide robust evidence for value for money and ultimately improve care delivery. Stronger integration of health economics and implementation science may also shed more light on the equity impacts of implementation strategies and guide their further design to promote more equitable care and outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-026-02933-x.

Keywords: Translational research, Diffusion of innovation, Transdisciplinary research, Interdisciplinary research, Process evaluation, Cost-effectiveness analysis, Value of information, Health equity

Background

There are well-recognised delays and inappropriate variations in the uptake of evidence-based practices [1]. Patients may fail to receive treatments of established clinical effectiveness or may receive low-value or even harmful treatments, which compromise the quality and outcomes of care. Implementation scientists and health economists can both provide significant contributions to the efficient, effective and equitable spread of evidence-based practices. Implementation science is the “scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and, hence, to improve the quality and effectiveness of health services and care” [2]. Implementation scientists investigate the optimal strategies to translate evidence into practice, and health economists explore the trade-offs between the costs and benefits of alternative courses of action.

Despite implementation costs being an important determinant of the adoption of evidence-based practices [3], economic evaluations are under-represented in the implementation literature relative to the number of intervention studies [4, 5], and implementation costs and processes are often neglected in economic evaluations of evidence-based practices [6, 7]. While some discussions in the respective fields exist [8, 9], the current discourse focuses on comparing the cost-effectiveness of implementation strategies and determining the cost of various implementation strategies without a full integration of how the implementation of an intervention can impact its effectiveness and cost-effectiveness. We propose a broadening of scope into how implementation scientists and health economists can work together across the research life cycle. Siloed methodological approaches may result in missed opportunities to optimise implementation strategies and provide robust evidence for value for money via joint exploration of cost-effectiveness of interventions and their implementation strategies.

Advancements in implementation science must be underpinned by theoretically informed empirical research. Similarly, high quality translational research requires robust health economics analysis. Integrating the disciplines of implementation science and health economics focuses efforts on utilising economic determinants in implementation strategy development. Greater collaboration between implementation scientists and health economists has the potential to advance the field, improve the delivery of relevant evidence for decision-makers and thereby improve patient care. However, there are gaps in the literature as to how to achieve this practically.

Methods

We convened a 3-day workshop in July 2024, which brought together 30 implementation scientists, health economists, patient contributors, and patient and public involvement and engagement (PPIE) researchers from Australia and the United Kingdom. The aim of the workshop was to develop a methodological framework for the incorporation of health economics in implementation research. Workshop attendees shared evidence, experiences and reflections on best practices for integrating health economics and implementation science through a series of presentations and breakout sessions. An additional file contains the workshop programme booklet, including the workshop’s goals and agenda, to provide context between the workshop and the findings reported in this paper [see Additional file 1]. There was a clear appreciation for the need for both disciplines to work together and leverage existing methods, theories and concepts rather than create additional frameworks. A shared vision for moving from siloed to synergistic disciplinary approaches was derived through consensus.

Results

This paper summarises the workshop findings and lessons that led us to a shared vision of an innovation pathway depicted in (Fig. 1). We make the case for integrating health economics and implementation science along the pathway, from the development and evaluation of an intervention through to eventual uptake and spread.

Fig. 1.

Fig. 1

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The innovation pathway: opportunities for aligning health economics and implementation science

Although Fig. 1 presents a linear pathway, we acknowledge the research-implementation cycle is seldom linear and straightforward. There is also more than one approach or attempt to support implementation. We draw upon this pathway to identify the opportunities for integration. In doing so, we do not propose that our list is exhaustive, but instead focus on practical and innovative approaches to enhance collaboration among implementation scientists, health economists, methodologists, the wider research team and key interest groups including people with lived experience, health care staff at all levels such as clinicians and managers, research funders, policymakers, payers and the public.

Current state of affairs and the urgent need for inter-disciplinary integration

Health economic analyses can play a clear role in planning and advocating for implementation, including supporting the building of “business cases” or “early value assessments” of interventions by implementers and policymakers [10, 11]. Economic evaluations of interventions typically begin with a decision problem and compare alternative patient pathways after receiving an intervention. An economic evaluation alongside an implementation study compares implementation strategies. One example is EQUIPD (Evaluation of Quality Improvement for People with Diabetes) [12], a cluster randomised controlled trial examining the cost-effectiveness of two concomitant strategies: national audit feedback plus quality improvement collaborative versus standard feedback alone (standard care). Dual reporting of the effectiveness and cost-effectiveness of the intervention and implementation strategy is suggested with hybrid effectiveness-implementation trials [13], but reporting the intervention and implementation strategy in an economic evaluation can be done regardless of whether researchers are comparing implementation strategies. An example is an economic evaluation of a brief psychological treatment for severe depression in primary care in India [14]. Researchers compared the cost-effectiveness of the brief psychological treatment with usual care and also described the inclusion of home-based delivery, patient resource materials and other implementation strategies [14]. These implementation strategies were thoroughly described but not tested or compared to determine cost-effectiveness.

Process evaluations can shed light on one or more of intervention fidelity, mechanisms of action and contextual influences from the development and evaluation of an intervention through to eventual uptake and spread [15]. While outcome evaluations (studies evaluating the effectiveness of interventions) are common, process evaluations offer an opportunity to generate contextual evidence essential for key interest groups when implementing and sustaining interventions. Conducting a process evaluation during a pilot or feasibility study can also provide a useful framework and forum for inter-disciplinary conversations, where implementation scientists and health economists interact with patients and public collaborators and clinicians to design or refine data capture plans for a future full study.

Choosing the best approach for evidence generation must consider which data are relevant to evidence users to guide and help monitor progress towards accelerated uptake of evidence-based practices. Potential evidence users and decision-makers, as well as research funders, may find it difficult to prioritise implementation and economic evidence alongside clinical effectiveness evidence. Published studies of effective interventions may lack contextual details, including implementation costs and needs, thereby limiting their utility for decision-makers if the perspective used does not reflect the realities of the environment in which the decision-maker is working [16]. Furthermore, the study outcomes may not reflect the information most useful to all evidence users. For example, cost-effectiveness evidence in terms of incremental cost per quality-adjusted life-year (QALY) gained for implementing an intervention is useful for higher-level policymakers and funders, whereas healthcare service providers may also benefit from costing information or budget impact analysis [17]. Generating evidence that is not fit for purpose, and which lacks necessary information to inform timely decision-making, comes with significant opportunity costs.

Methodological innovations at the intersection of health economics and implementation science

Combining evidence of the intervention and implementation process at the outset of research represents a growing area of methodological innovation [8, 18]. The methods which we believe will support methodological advances - and importantly, multidisciplinary integration of health economics and implementation science - include although are not limited to Value of Implementation and Value of Information analyses [19]. Both can be undertaken prior to conducting more detailed research to justify whether implementation efforts are worth pursuing and prioritise which interventions to scale up. However, an understanding of current practice is required. For example, national registries or administrative datasets can be used to ascertain guideline adherence. Value of Implementation analysis then estimates the expected value of investing in different implementation strategies and the opportunity costs (benefits foregone) of suboptimal or current implementation [20]. The analysis quantifies the potential return on investment of implementation strategies regarding its expected effects on adoption rates and implementation costs (see Case study: Prevention of Cerebral Palsy in PreTerm Labour [PReCePT]). Value of Information analysis estimates the value of further research in terms of reducing parameter uncertainty and research costs [21]. We believe conducting Value of Information and Value of Implementation analyses may be appropriate when the evidence for the effectiveness and cost-effectiveness of the intervention and implementation is less established.

Case study: prevention of cerebral palsy in preterm labour (PReCePT)

Antenatal magnesium sulphate (MgSO4) is an effective and cost-effective treatment in reducing the risk of cerebral palsy in babies born prematurely [22–24]. However, its implementation has been slow and varied between maternity units in England [25]. In 2014, only 36% of eligible preterm babies (< 30 weeks’ gestation) benefited from this treatment, resulting in almost £75 m (2022 prices) forgone due to this suboptimal implementation, meaning that cases of cerebral palsy and its wide societal and lifetime consequences were not prevented [26, 27]. This called for further investment to close this research-to-practice gap. The National PReCePT Programme was launched in England in 2018 as a national quality improvement initiative for maternity units, providing clinical guidance, training, learning resources, midwife backfill funding, and quality improvement support, to boost MgSO4 uptake at a cost of £935k [25, 28]. Our most recent evaluation shows that the National PReCePT Programme represented good value for money as it boosted the uptake of MgSO4 in the first year: PReCePT generated a net monetary benefit of more than £1 m from a societal and lifetime perspective [26, 27]. Nevertheless, MgSO4 uptake is still far from optimal (82% in 2022 versus an optimal 95%) with high variation in practice among units 26, 27. We have calculated that the benefit forgone of not implementing MgSO4 optimally is still beyond £18 m [26]. This emphasises the need for further investment in implementing MgSO4 and sustaining adoption. Value of Implementation analysis can also be used to compare the value for money of implementation strategies [29], guiding decision-making for the prevention of cerebral palsy in preterm labour.

The importance and role of context in navigating the integration of health economics and implementation science

We define the intervention as the evidence-based practice requiring implementation (or the low-value practice to de-implement) and the implementation strategy as the method used to increase or decrease intervention use. The implementation process is the dynamic interaction of the intervention, implementation strategy and context over time. Sometimes it can be challenging to disentangle these within a care package, but distinguishing between the intervention and the implementation strategy is critical to clarify the cost-effectiveness (both benefits and costs) of the intervention versus the implementation strategy and the impact of context on these [18]. For example, the CAVA clinical trial recently demonstrated the superiority of implantable ports, compared with either peripherally inserted central catheters (PICCs) or Hickman lines, in terms of the reduction in complication rates, when these devices were used to deliver long-term anti-cancer treatment [30]. The insertion of a port is typically undertaken by a radiologist in a theatre setting. However, with appropriate training, this procedure can be safely undertaken by a nurse in a basic procedure room. A cost-effectiveness analysis found that, while a radiologist-led service would reduce complications and increase costs, a nurse-led service for port insertion had the potential to reduce complications with comparable overall costs [31]. Therefore, careful distinction between the intervention and the implementation strategy regarding benefits and costs may help local decision-makers determine the projected value of the intervention and implementation feasibility in their local context.

Context often influences the effectiveness of interventions, where they are effective in some settings and targeted problems but ineffective or even harmful for others [32]. Context also influences implementation costs, including staff, capacity and infrastructure [33]. There may also be additional implementation costs related to designing new or adapting existing interventions for a local context [34]. Reporting contextual components, as well as implementation requirements such as training costs, personnel time and resource availability, can support local decision-makers to determine whether implementation is feasible. Consideration in the research design stage of the interaction between the components and the local context can ensure these are adequately tested during the development and implementation of the intervention, e.g. can the service be delivered by someone with fewer qualifications, or can the service be delivered online instead of in person, or flexibly depending on patient preference and staff availability?

The intervention, implementation strategies and context are several important aspects where collaboration between implementation scientists, health economists, methodologists, the wider research team and key interest groups is important. Practitioners, organisations and researchers need to address different drivers and influences upon implementation across different contexts. Involving and engaging with key interest groups in discussions regarding implementation barriers and enablers is critical, given the anticipated effects of implementation strategies largely depend upon organisational and behaviour change involving these groups [35]. Additionally, important uncertainties remain about how best to align implementation influences with strategies [36]. Researchers may have uncertainty about what the possible implementation pathways are if they do not consult with a range of people who are affected by any future changes (intentionally or unintentionally). Articulating the implementation pathway supports coherence, assessment of fidelity and later replication in future implementation research [37]. Conceptual consensus among implementation scientists, health economists, the wider research team and key interest groups is required to determine how the intervention combines with the patient and healthcare pathways (i.e., intervention features), influences upon these pathways (i.e., barriers, enablers and contextual components) and prioritisation of the most promising implementation strategies to address these influences. Involving lived experience and public contributors in combined implementation and economic discussions at an early stage through co-design methods and qualitative methods can identify where unintended impacts may occur and how to quantify and ideally avoid them.

Discussion

There is a need for a shared understanding and language of how to integrate health economics and implementation science at the outset of all pragmatic research, as well as throughout the entire study design and conduct. We have outlined how implementation scientists and health economists can work together along the innovation pathway as well as collaborate with methodologists, the wider research team and key interest groups to enhance both evidence generation and research translation. Methods such as process evaluation, Value of Information analysis and Value of Implementation analysis advance collaboration beyond determining the cost and cost-effectiveness of implementation strategies. Furthermore, consideration of contextual components and implementation requirements from the outset can improve research and intervention design, and lead to greater implementation and adoption of effective and cost-effective interventions.

Impacts on equity

Lags in research translation disproportionately affect those with the greatest need, as evidenced by widening health inequities despite increasing research investment [38]. Therefore, any methodological advances which bridge health economics and implementation science need to consider equity. Current methodological approaches do not adequately address equity which represents a significant limitation. In addition to establishing whether there is meaningful value in ‘scaling’ the intervention universally, Value of Implementation analysis can model the value of implementation strategies that ‘spread’ the intervention to those people who need it most. Improving equity may require targeted implementation strategies to increase access and quality of care for priority populations. An implementation strategy that produces overall greater population health gains may exacerbate inequities and therefore be unappealing to policymakers and the public. However, a targeted implementation strategy may produce smaller population health gains but improve equity. That is the case of the Common Ambition Bristol (CAB) programme [39] which aims to reduce HIV inequities in African and Caribbean heritage communities in Bristol by increasing the uptake of HIV testing and access to pre-exposure prophylaxis (PrEP). Measuring the equity impacts of implementation strategies may require incorporating long-term impacts of implementation and adjusting willingness to pay thresholds to advocate for investment in these approaches. This may also support the de-implementation of interventions that are not effective or exacerbate inequities.

There is potential to incorporate equity considerations into Value of Implementation analysis; for example, increasing the willingness to pay threshold to achieve higher intervention adoption rates among priority populations. Furthermore, disproportionately improving adoption rates in populations who have lower baseline adoption rates may lead to greater returns on investment in implementation activities than marginally improving adoption rates across the service. A collaborative approach to early economic analyses and generating economic and implementation evidence within evaluations represents an opportunity to develop and test the effects of implementation strategies on intervention adoption rates among priority populations to determine whether health inequities are reduced or exacerbated. Given its implications for advancing health equity across different contexts, this is an area worthy of further methodological development.

Conclusions

Multidisciplinary research is more effective in generating insightful and impactful research and outcomes, especially within the context of limited resources and the transition to integrated models of health care delivery. Disciplinary divides between health economics and implementation science may result in missed opportunities to optimise implementation strategies and provide robust evidence for value for money. There is a need for a shared understanding of how to integrate health economics and implementation science into the entire study design and conduct from the outset of all research, rather than purely as individual work packages or add-on after an effectiveness study [9]. As a multi-disciplinary and international group including health economists, implementation scientists and PPIE collaborators, we recognise and acknowledge the potential benefits of greater collaboration and understanding across our fields. Namely, we call for more implementation-focused robust economic evaluations, better disciplinary integration from the outset and outputs that are tailored to decision-makers’ needs. We believe disciplinary integration and a shared methodological understanding is also critical to drive health equity, particularly for priority populations, to increase their access to, and adoption of, effective services across health and social care.

Supplementary Information

12874_2026_2933_MOESM1_ESM.pdf (123.1KB, pdf)

Additional file 1: Advancing implementation science: integrating health economics for effective implementation workshop.

Acknowledgements

Davide Tebaldi is grateful to Professor Davide Meads of the Academic Unit of Health Economics at the Leeds Institute of Health Sciences, University of Leeds, England. Professor Meads conceptualised the health economics analysis for the EQUIPD project and provided valuable supervision to Davide Tebaldi during the drafting of the paper. Kamran Khan and Carrol Lamouline also attended the workshop. This report is independent research supported by the National Institute for Health and Care Research Applied Research Collaboration South West. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health and Care Research or the Department of Health and Social Care.

Abbreviations

CAB

Common Ambition Bristol

EQUIPD

Evaluation of Quality Improvement for People with Diabetes

MgSO4

Magnesium sulphate

PICC

Peripherally inserted central catheter

PPIE

Patient and public involvement and engagement

PReCePT

Prevention of Cerebral Palsy in PreTerm Labour

PrEP

Pre-exposure prophylaxis

QALY

Quality-adjusted life-year

Authors’ contributions

All authors attended the workshop and contributed their expertise to the article. LM led the drafting of the article. All authors read and approved the final manuscript.

Funding

The workshop was supported by the Monash Warwick Alliance Activation Fund. Carlos Sillero-Rejon and Hugh McLeod are supported by the National Institute for Health Research Applied Research Collaboration (NIHR ARC) South West at University Hospitals Bristol National Health Service Foundation Trust. Caroline Clarke was supported by the National Institute for Health and Care Research University College London Hospitals Biomedical Research Centre. Amy Grove, Graeme Currie, Agnieszka Latuszynska and Paul Bird are supported by the NIHR ARC West Midlands (WM). Sophie Staniszewska is part funded by NIHR ARC WM, NIHR HPRU GI, NIHR HPRU GED, NIHR WM ESG, and NIHR HDRC Coventry. Robbie Foy is supported by NIHR ARC Yorkshire and Humber. Sarah Alderson is supported by an NIHR Advanced Fellowship. Alisa Higgins is supported by a National Health and Medical Research Council (NHMRC) Investigator Grant. The funding bodies played no role in the conceptualization, design, decision to publish, or preparation of the manuscript.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Footnotes

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Alisa M Higgins and Amy L Grove are Joint senior (last) authors.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

12874_2026_2933_MOESM1_ESM.pdf (123.1KB, pdf)

Additional file 1: Advancing implementation science: integrating health economics for effective implementation workshop.

Data Availability Statement

No datasets were generated or analysed during the current study.

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