Journal article
Economic evaluation of implementation science outcomes in low- and middle-income countries: a scoping review
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Publication Details Author list: Malhotra A, Thompson RR, Kagoya F, Masiye F, Mbewe P, Mosepele M, Phiri J, Sambo J, Barker A, Cameron DB, Davila-Roman VG, Effah W, Hutchinson B, Laxy M, Newsome B, Watkins D, Sohn H, Dowdy DW Publication year: 2022 Journal name in source: IMPLEMENTATION SCIENCE Volume number: 17 Issue number: 1 ISSN: 1748-5908 |
Background: Historically, the focus of cost-effectiveness analyses has been on the costs to operate and deliver inter‑ ventions after their initial design and launch. The costs related to design and implementation of interventions have often been omitted. Ignoring these costs leads to an underestimation of the true price of interventions and biases economic analyses toward favoring new interventions. This is especially true in low- and middle-income countries (LMICs), where implementation may require substantial up-front investment. This scoping review was conducted to explore the topics, depth, and availability of scientific literature on integrating implementation science into economic evaluations of health interventions in LMICs. Methods: We searched Web of Science and PubMed for papers published between January 1, 2010, and December 31, 2021, that included components of both implementation science and economic evaluation. Studies from LMICs were prioritized for review, but papers from high-income countries were included if their methodology/findings were relevant to LMIC settings. Results: Six thousand nine hundred eighty-six studies were screened, of which 55 were included in full-text review and 23 selected for inclusion and data extraction. Most papers were theoretical, though some focused on a single disease or disease subset, including: mental health (n = 5), HIV (n = 3), tuberculosis (n = 3), and diabetes (n = 2). Manuscripts included a mix of methodology papers, empirical studies, and other (e.g., narrative) reviews. Authorship of the included literature was skewed toward high-income settings, with 22 of the 23 papers featuring first and senior authors from high-income countries. Of nine empirical studies included, no consistent implementation cost out‑ comes were measured, and only four could be mapped to an existing costing or implementation framework. There was also substantial heterogeneity across studies in how implementation costs were defined, and the methods used to collect them. Conclusion: A sparse but growing literature explores the intersection of implementation science and economic evaluation. Key needs include more research in LMICs, greater consensus on the definition of implementation costs,
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