Tzeyu Michaud PhD Department of Health Promotion UNMC tzeyumichaudunmcedu Overview Role of costs in dissemination amp implementation research Principle of costing Cost data collection guide ID: 1039964
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1. Costing out interventions in D & I ResearchTzeyu Michaud, PhDDepartment of Health Promotion, UNMCtzeyu.michaud@unmc.edu
2. OverviewRole of costs in dissemination & implementation researchPrinciple of costingCost data collection guideExample/ template
3. Role of Costs in D & I ResearchHigh-cost intervention was created to achieve large effect sizeCosts are critical to ensuing broad-scale adoption & implementationIncrease intervention impact by maximizing reach and adoptionCost data should be published to facilitate the development of more realistic and scalable interventions
4. Principle of Costing
5. Intervention TypeTypeExampleTreatmentPharmaceuticalsProphylactic treatmentAspirinDiagnosticsChanges in diagnostic protocols with introduction of new treatmentsScreening programColorectal cancer screeningDelivery of serviceCare coordinatorHealth Promotion programWeight management programRegulatory/ policySugar-sweetened beverage tax.; alcohol & tobacco taxMarketing/ education campaignsHealth promotion (exercise, diet)
6. Type of PerspectiveSocietalHealthcare sectorPayersClinic, worksite, & local community group (small organization)Clinicians and implementing staffParticipant/family
7. General Perspectivecost components/perspectiveSocietalHealthcare sectorPayersDirect medical costspaid by payersYesYesYesout-of-pocketYesYesNoDirect non-medical costs (e.g. transportation, unpaid caregiving time, or patient time) YesNoNoIndirect costs (e.g. loss of productivity) YesNoNo
8. Implementation PerspectiveRhodes, Jones, et al. "Stakeholder perspectives on costs and resource expenditures: tools for addressing economic issues most relevant to patients, providers, and clinics." Translational behavioral medicine (2018).
9. What Costs to be included?ResearchGrant administrationAcquisition of IRB approvalTiming administering & analyzing assessmentsManuscript preparationDevelopmentProtocolWebsite designTelephone script productionOthers (i.e. Newsletter of handout)RecruitmentIntervention/ImplementationIntervention Costs
10. Treatment & Preventive TreatmentKey Intervention componentDiagnostic & investigational proceduresAcquisition & administration cost of treatmentHealth professional servicesPatient support and careMarketing & Media costsIdentification and participation of target populationPersonnel costs (if not included yet)Overhead (i.e., utilities & facilities)Intervention-specific equipment
11. Screening & Health PromotionIntervention componentAdvice, consultations, care/services, products, Screening kits and sample testing (if applicable)Communication of results/progressMarketing & Media costsIdentification & enrollment of eligible participantsRecruitment & training providersReferral (and possible treatment) of identified cases of diseaseOngoing monitoring of program performance
12. Regulatory & PolicyCost of passing a statute or regulationMarketing and media costsEnforcement costsEvaluation or monitoring of outcomes
13. Target population (3,234 participants)With impaired glucose tolerance25 years of age & olderBMI ≥24 kg/m2Intervention armLifestyle change: 16 lessons in the first 24 weeks, and then every 2 months meet with case managers with at least 1 phone call between visitsMetformin: 850 mg of metformin twice a day Placebo: took a placebo twice a dayCost categoriesDirect medical costsDirect non-medical costsIndirect costsDiabetes Prevention Program Research Group. "Costs associated with the primary prevention of type 2 diabetes mellitus in the diabetes prevention program." Diabetes care26.1 (2003): 36-47.
14. Direct Medical CostsLifestyle changeMetforminPlaceboBaseline history & physical examExercise testCore curriculum & materialsSupervised activity sessionsGroup sessionsIn-person visitPhone calls & reminder phone callsOverheadStandard life style recommendationBaseline history & physical examLabVenipunctureSerum creatinineHemoglobin/hematocritUrine creatinineMetformin Follow-up visitDose-titration/restart visitsPhone calls & reminder phone callsOverheadAnnual visitMaterialsPhone calls & reminder phone callsOverhead
15. Other CostsDirect non-medical costsParticipant timeStudy visitsLeisure-time PAShopping & cookingPurchase of serviceExercise classHealth club personal trainerWeigh loss classFitness equipmentFood equipmentShoesFoodTransportationIndirect cost (productivity loss)Morbidity lossMortality loss
16. Template- Treatment Perspective:__________Study arm/Cost categoryDirect Medical CostsDirect non-medical CostsIndirect CostsIntervention AIntervention Betc.
17. Target population (320 participants)Aged 18 and olderSmoked ten or more cigarettes per day Study armIntervention: four telephone counseling sessions, four tailored newsletters, and one targeted newsletter.Usual care: generic health education mailingsRitzwoller, Debra P., et al. "Costing behavioral interventions: a practical guide to enhance translation." Annals of Behavioral Medicine 37.2 (2009): 218-227.
18. Cost ComponentsRitzwoller, Debra P., et al. "Costing behavioral interventions: a practical guide to enhance translation." Annals of Behavioral Medicine 37.2 (2009): 218-227.Fixed costsFacilities (office space)Equipment/ technologyVariable CostsPersonnel & other laborSuppliesBuilding operating & maintenanceTraining & educationAdministrativeOperating
19. Template- Health Promotion Program Project phase/Cost categoryFixed CostsVariable CostsResearchDevelopmentRecruitmentIntervention/ImplementationPerspective:__________
20. Source of Data CollectionAdministrative data baseSurvey for providers and beneficiariesObservational studiesExpert panelPublished price list (e.g. average wholesale price)Published literatureOthers
21. SummaryPlan ahead (study design)Identify intervention type & perspective Ask for help
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