Table 1.

Expected resource requirements and potential benefits of conducting economic evaluations of intervention implementation by implementation phase

EPIS Phase	What resources or efforts may be expended when conducting economic evaluations at each phase of implementation?	What can be gained by conducting economic evaluations at each phase of implementation?
Exploration	• Reflect on insights from intervention studies in other contexts. Identify the similarities and differences to the local context. • Assess organization’s priorities, available resources, and outcomes of interest.	• Assess evidence from other implementation studies and economic evaluations to support decision-making about which EBIs and implementation strategies to adopt for the target population and setting. • Obtain an initial list of relevant costs and resources to include in economic evaluation from prior studies.
Preparation	• Determine what usual care looks like and what the intervention will need to include (e.g., which implementation strategies will work). • Identify boundaries of the intervention. • Map cost data collection activities onto systems maps to guide methods for estimating costs. • Document resources needed to accomplish upfront tasks (training, development of electronic health record systems, etc.). • Consider who and what is needed to successfully implement the intervention.	• Assess evidence from other implementation studies and economic evaluations to select and tailor implementation strategies to optimize return on investment for intended EBI, population, and setting. • Gain an understanding of potential “voltage drops” (i.e., process steps that reduce the overall effectiveness of the intervention) and which resources and costs may be required to address these gaps. • Develop a comprehensive list of cost and fidelity measures to collect and evaluate during the implementation phase.
Implementation	• Track all cost and fidelity measures on a regular basis. • Ask implementation agents about their resource adequacy, time spent on specific activities, and suggestions for improvement. • Streamline tasks based on understanding and specificity of the intervention boundaries. • Consider possible adaptations.	• Gather data on cost and fidelity measures collected on an ongoing basis during intervention implementation that will inform the economic evaluation. • Estimate the time required to implement each step of the intervention, including labor-intensive activities. • Obtain feedback from key stakeholders (patients, implementation agents, decision-makers, etc.) on the costs and benefits of the intervention.
Sustainment	• Estimate the short-term and long-term cost-effectiveness of the intervention. Evaluate the relative impact of uncertainties on the overall cost-effectiveness. • Continue to support anyone with a task in implementing the complex intervention. Identifying who has to do what and what is needed to do it well will help others in the Exploration phase. • Conduct ongoing assessment to identify any changes over time in the resource requirement and the impact on costs.	• Generate evidence to support decision-making on adaptation and sustainment of the intervention. • Estimate the cost-effectiveness of the intervention compared to other alternatives for the outcomes of interest. • Gather input from key stakeholders on how to create economies of scale.