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Table 2 Differences in the content of steps for conducting economic and financial evaluations of mHealth solutions

From: Defining a staged-based process for economic and financial evaluations of mHealth programs

Steps Full economic evaluation Costing study Cost description analysis Cost outcome description analysis Budget impact analysis Financial forecasting for scale
Define the objective Identify the research questions, define the purpose of the work, audience for and intended use of information; Objective should clearly state the perspective, population, locations, time horizon, and for full economic evaluation, the comparator and outcomes selected
Define the perspective or viewpoint from which the analysis is undertaken Societal perspective is considered gold standard; collection of all perspectives allows for scenarios to be presented for individual perspectives (program, user, payer, health systems) Program perspectivea most common MEEP: Societal perspective [31] ISPOR: Program perspective Program perspective
Define the intervention Target population size and characteristics, Target disease(s), Delivery sites, Technology and architecture systems, Activities required to develop, start-up and maintain implementation
Define the comparator against which costs and effects are measured Minimally the following comparators should be assessed: Interventions/program or mix currently available to the population The most cost-effective alternative ‘do nothing’ analysis representing non-interventional care for the population [31] Not applicable; single program Minimally the following comparators should be assessed: Interventions/program or mix currently available to the population The most cost-effective alternative ‘do nothing’ analysis representing non-interventional care for the population Not applicable; single program
Define the time horizon, including the time frame (period in which intervention is applied) and analytic time horizon (period for which costs and consequences are considered) [57] Trial based evaluations Time frame aligned with program duration Model based Defined by analyst should be of sufficient length to capture all costs and effects relevant to the decision problem Time horizon of relevance to the budget holder; 1 to 5 years is most common but may vary by country/organization and therefore reasons for choice should be stated
Identify, measure, and value consequences Measure of health outcome specific to the decision problem; should capture positive and negative effects on length of life and quality of life; should be generalizable across disease states [31] CBAs may include non-health outcomes Many studies may include synthesis estimates if effects on multiple target groups are anticipated Since results may be sensitive to outcome, it may be useful to test several Not applicable Measure of outputs/health outcome specific to the decision problem; should capture positive and negative effects on length of life and quality of life; should be generalizable across disease states Impact on health outcomes may be forecasted
Identify, measure, and value costs Use of economic costs or approximations Primary vs secondary data source Data reported on expected resource use and costs of delivery to the target population(s) Overall costs of interventions reported as well as costs of resource inputs Categorization of costs: capital vs. recurrent, fixed vs. semi variable vs. variable costs Annualization of capital and fixed costs over the period of implementation [31] Discounting/constant prices Inflation to base year Converting costs into USD For some analyses, converting to international dollars with purchasing power parities may also be indicated Use of financial costs most common Data reported on expected resource use and costs of delivery to the target population(s) Overall costs of interventions reported as well as costs of resource inputs Categorization of costs: capital vs. recurrent, fixed vs. variable Annualization of capital and fixed costs over the period of implementation [31] Adjusting estimated unit costs to the year of reported costs Converting costs into USD Use of direct costs (exclude overheads) [50] Categorization of costs: Capital vs. recurrent, fixed vs. variable Annualization of capital and fixed costs over the period of implementation [31] (if applicable) No discounting [50] Converting costs into USD [31] Use of financial costs/actual acquisition cost of intervention Data reported on expected resource use and costs of delivery to the target population(s) Overall costs of interventions reported as well as costs of resource inputs Categorization of costs: capital vs. recurrent, fixed vs. variable Annualization of capital and fixed costs over the period of implementation [31] Adjusting estimated unit costs to the year of reported costs Converting costs into USD
Modeling and analysis Use of decision-analytic model Decision tree Markov model (individual-level/microsimulation or cohort), Discrete-event simulation Net benefit regression Extended cost-effectiveness analyses Compartmental model Estimation of costs for alternatives by year of implementation; Analysis of key drivers of costs Estimation of costs for single program by year of implementation; Analysis of key drivers of costs Estimation of costs for single program by year of implementation; Division of cost by key outcome measures; Analysis of key drivers of costs One of 3 analytic frameworks: BIA cost calculator, Condition-specific cohort, or Individual simulation model [50] Validation of computing framework and input data Estimation of costs for alternatives by year of implementation; Analysis of key drivers of costs Application of TCO model or other simple excel based spreadsheet
Account for uncertainty Recommended assessment of 3 types of uncertainty: Structural uncertainty introduced by the assumptions made Source of values for parameter estimates Parameter precision—uncertainty around the mean health and cost inputs in the model Gold standard is to conduct Probabilistic sensitivity analysis. This enables the uncertainty associated with parameters to be assessed simultaneously and incorporated in the results of the model Threshold, univariate and multi-variate sensitivity analyses are most commonly used Parameter uncertainty in the input values used Structural uncertainty introduced by the assumptions made in framing the BIA Threshold, univariate and multi-variate sensitivity analyses are most commonly used Adjustment for optimization bias and risk exposure
Interpret and present results Study parameters Summary of incremental costs and consequences Cost effectiveness plane Tornado diagram/threshold analyses Cost effectiveness acceptability curve Characterizing heterogeneity Discuss generalizability Describe underlying assumptions Summary of unit costs Summary of aggregate and sub-category costs by activity and level of the health system for each year of implementation for each alternative Summary of unit costs Summary of aggregate and sub-category costs by activity and level of the health system for each year of implementation Design of the BIA reported Disaggregated and annualized BIA which demonstrates implications on Government and social insurance budgets; Households and out of pocket expenses; Third-party payers; and External donors [50] Both budget period resource use and costs should be presented Summary of unit costs Summary of aggregate and sub-category costs by activity and level of the health system for each year of implementation
Ensure quality in reporting your evidence Drummond Checklist [25] and/or CHEERS checklist screening [58]; MEEP principals for Economic Evaluation [31] Reporting standards not available; select components of the CHEERS checklist can be applied ISPOR principles of good practice [50] Donor specific reporting standards
  1. Synonymous with budget holder perspective