|EPIS Phase||What resources or efforts may be expended when conducting economic evaluations at each phase of implementation?||What can be gained by conducting economic evaluations at each phase of implementation?|
• Reflect on insights from intervention studies in other contexts. Identify the similarities and differences to the local context.|
• Assess organization’s priorities, available resources, and outcomes of interest.
• Assess evidence from other implementation studies and economic evaluations to support decision-making about which EBIs and implementation strategies to adopt for the target population and setting.|
• Obtain an initial list of relevant costs and resources to include in economic evaluation from prior studies.
• Determine what usual care looks like and what the intervention will need to include (e.g., which implementation strategies will work).|
• Identify boundaries of the intervention.
• Map cost data collection activities onto systems maps to guide methods for estimating costs.
• Document resources needed to accomplish upfront tasks (training, development of electronic health record systems, etc.).
• Consider who and what is needed to successfully implement the intervention.
• Assess evidence from other implementation studies and economic evaluations to select and tailor implementation strategies to optimize return on investment for intended EBI, population, and setting.|
• Gain an understanding of potential “voltage drops” (i.e., process steps that reduce the overall effectiveness of the intervention) and which resources and costs may be required to address these gaps.
• Develop a comprehensive list of cost and fidelity measures to collect and evaluate during the implementation phase.
• Track all cost and fidelity measures on a regular basis.|
• Ask implementation agents about their resource adequacy, time spent on specific activities, and suggestions for improvement.
• Streamline tasks based on understanding and specificity of the intervention boundaries.
• Consider possible adaptations.
• Gather data on cost and fidelity measures collected on an ongoing basis during intervention implementation that will inform the economic evaluation.|
• Estimate the time required to implement each step of the intervention, including labor-intensive activities.
• Obtain feedback from key stakeholders (patients, implementation agents, decision-makers, etc.) on the costs and benefits of the intervention.
• Estimate the short-term and long-term cost-effectiveness of the intervention. Evaluate the relative impact of uncertainties on the overall cost-effectiveness.|
• Continue to support anyone with a task in implementing the complex intervention. Identifying who has to do what and what is needed to do it well will help others in the Exploration phase.
• Conduct ongoing assessment to identify any changes over time in the resource requirement and the impact on costs.
• Generate evidence to support decision-making on adaptation and sustainment of the intervention.|
• Estimate the cost-effectiveness of the intervention compared to other alternatives for the outcomes of interest.
• Gather input from key stakeholders on how to create economies of scale.