Item 13. Methods: Economic evaluation.

Methods for resource use, costs, economic outcomes and analysis for the implementation strategy	Methods for resource use, costs, economic outcomes and analysis for the intervention
Examples Economic evaluation of the implementation strategy	Economic evaluation of the intervention
Cost analysis of developing and implementing the three interventions from a national perspective (cost of rolling out a particular intervention across the NHS)…20	… from the perspective of a single trust (cost of all activity and resource used by trust employees in implementation)20
Financial data were obtained for the costs of setting up and running the Improving Access to Psychological Therapies (IAPT) service for the 2 years of the study, including training, equipment, facilities and overheads, to provide estimates of the costs associated with IAPT. Set-up costs were a small proportion of total costs (less than 10%) and these were therefore apportioned to this 2-year period rather than the lifetime of the service.70	The service recorded contact … time in minutes for each service user and this was used to calculate total contact time over the 2 years, which was combined with total cost data to generate an average cost per minute for the IAPT service… All health and social care services [were] valued using national unit costs. A broader perspective of costs was taken by assessing productivity impact, which we valued using the lost number of days from work using a human capital approach.70
Explanation Economic evaluation can inform future implementation and commissioning decisions. Reporting should adhere to existing guidelines relevant to the study design (eg, the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) task force guidelines for economic evaluation (including model-based economic evaluation)71 and budget impact analysis,72 and guidance on social return on investment approaches73). This may require an online supplementary file or a separate publication. An additional requirement in reporting implementation research is to relate economic information to the implementation strategy or the intervention that is being implemented. If possible, reporting should distinguish between the two, with the practicality of doing so ideally having been considered at design stage. A budget impact analysis estimates changes in the expenditure of a healthcare system after adoption of a new intervention, and will be of particular interest to those who plan healthcare budgets.72 Reporting should be transparent and cover the following aspects of the evaluation, as relevant: Target/eligible population, health system, setting, location and comparator(s). Perspective (ie, which resources and costs are being considered) using an equivalent approach for intervention and comparator scenarios, with additional and separate estimates specifically related to the implementation strategy and intervention. Time horizon of the evaluation and (if relevant) the discount rate used. Methods and sources used to derive resource use and cost estimates. Currency, price date and any conversions. Outcome/effectiveness measure(s). Statistical approaches for analysis of resource use, costs and outcomes, including handling of joint distributions between these parameters, handling of missing data and any specific considerations, for example, cluster randomisation.74 For models and budget impact analyses, the choice of model/framework, its structure (with graphical representation) and methods for checking consistency and validity. For approaches that report composite cost and outcome metrics (eg, incremental cost-effectiveness ratio (ICER) or probability of cost-effectiveness against a given willingness-to-pay threshold), the outcome should be clearly specified and justified (particularly if it is not the same as the primary outcome for the related effectiveness evaluation). Assumptions made, and any planned sensitivity/scenario analyses to explore the impact of such assumptions.