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Int J Qual Health Care. 2019 Jul 10. pii: mzz059. doi: 10.1093/intqhc/mzz059. [Epub ahead of print]

Economic evaluation of guideline implementation in primary care: a systematic review.

Author information

1
Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany.
2
German Center for Vertigo and Balance Disorders, Faculty of Medicine, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany.
3
Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany.

Abstract

PURPOSE:

To review the economic evaluation of the guideline implementation in primary care.

DATA SOURCES:

Medline and Embase.

STUDY SELECTION:

Electronic search was conducted on April 1, 2019, focusing on studies published in the previous ten years in developed countries about guidelines of non-communicable diseases of adult (≥18 years) population, the interventions targeting the primary care provider. Data extraction was performed by two independent researchers using a Microsoft Access based form.

RESULTS OF DATA SYNTHESIS:

Among the 1338 studies assessed by title or abstract, 212 qualified for full text reading. From the final 39 clinically eligible studies, 14 reported economic evaluation. Cost consequences analysis, presented in four studies, provided limited information. Cost-benefit analysis was reported in five studies. Patient mediated intervention, and outreach visit applied in two studies showed no saving. Audit resulted significant savings in lipid lowering medication. Audit plus financial intervention was estimated to reduce referrals into secondary care. Analysis of incremental cost-effectiveness ratios was applied in four studies. Educational meeting evaluated in a simulated practice was cost-effective. Educational meeting extended with motivational interview showed no improvement; likewise two studies of multifaceted intervention. Cost-utility analysis of educational meeting supported with other educational materials showed unfavourable outcome.

CONCLUSION:

Only a minor proportion of studies reporting clinical effectiveness of guideline implementation interventions included any type of economic evaluation. Rigorous and standardized cost-effectiveness analysis would be required, supporting decision-making between simple and multifaceted interventions through comparability.

PMID:
31290962
DOI:
10.1093/intqhc/mzz059

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