National Centre for Education and Training on Addiction
Abstract
This document is Part Two of a 3-part series by the National Centre for Education and Training on Addiction (NCETA) examining the effectiveness, costs and theories related to dissemination and implementation of research into practice. Part One is a systematic literature review that evaluated the effectiveness of 16 different dissemination strategies for facilitating the implementation of new research, programs and treatments to improve outcomes for clients with alcohol and other drug-related problems. Part Two involves an examination of the costs associated with using such strategies, and Part Three is an examination of the theories and models of change underlying the use of strategies.
In this Part, the costs of implementing innovations and the implications of using dissemination strategies for the alcohol and other drug (AOD) field are examined. Part One in this series is a systematic review of the effectiveness of dissemination and implementation strategies (Bywood, Lunnay, & Roche, 2008). However, evidence related to economic considerations was not based on a systematic search using relevant terms associated with economic analysis. Rather, it is a summary of the evidence from the systematic review on effectiveness that also contained data on costs of using an implementation strategy.
All studies in Part One that showed evidence that a particular strategy was effective in changing practitioners’ behaviour or improving organisational efficiency were scrutinised to determine whether an economic analysis had also been undertaken. These studies then formed the evidence base for the present report.
An implementation strategy can be effective, without being cost-effective. Thus, from an economic perspective, the key question is whether certain dissemination and implementation activities involve a more efficient use of limited resources compared to other activities.
The key research questions for this study were:
1. What are the economic considerations for the use of effective dissemination and implementation strategies?
2. Which implementation strategies provide an efficient and cost-effective means by which to facilitate uptake of innovations by the AOD field?
The key findings from this review are:
• CME was generally effective and cost-effective, although formats differed substantially
• Educational outreach showed mixed results on cost-effectiveness
• Educational materials were relatively cheap, but had little effectiveness
• Multi-faceted approaches differed substantially in context and content, making it difficult to make meaningful comparisons on the basis of cost
• The evidence base of studies containing good quality economic analyses was limited (only 9 of the 16 strategies were evaluated for costs)
• Studies that reported on costs of implementation strategies were heterogeneous, reporting of details and quality of methodology was poor, and data collection was incomplete
• Few studies evaluated costs of implementation strategies in the AOD field
• There is a need for future evaluation studies to examine efficiency through use of economic evaluation
