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Background. A stepped-wedge, cluster randomized controlled trial assessed the effectiveness of practice facilitation (PF) for adoption of guidelines for prevention and treatment of cardiovascular disease risk factors. This study estimated the associated cost of PF for guideline adoption in small, private primary care practices.
Methods. The cost analysis included categories for start-up costs, intervention costs, and practice staff costs for the implemented PF-guided intervention. We estimated the total one-year costs to operate the program, and calculated the mean and range of the cost-per-practice by quarter of the intervention. We estimated the lower and upper bounds for all salary expenses, rounding to the nearest $100.
Results. Total one-year intervention costs for all 261 practices ranged from $7,900,000-$10,200,000, with program and practice salaries comprising $6,600,000-$8,400,000 of the total. Start-up costs were a small proportion (3%) of total one-year costs. Excluding start-up costs, quarter 1 cost-per-practice was the most expensive at $20,400-$26,700, and quarter 4 was least expensive at about $10,000. Practice staff time (compared with program staff time) was the majority of the staffing costs at 75-84%.
Conclusions. The PF strategy cost approximately $10,000 per practice per quarter for program and practice costs, once implemented and running at highest efficiency. Whether this program is “worth it” to the decision-maker depends on the relative costs and effectiveness of their other options for improving cardiovascular risk reduction.
Trial Registration. This study is retrospectively registered on January 5, 2016 at www.clinicaltrials.gov as NCT02646488. https://clinicaltrials.gov/ct2/show/NCT02646488
Keywords
practice facilitation, cost analysis, clinical guideline adherence, cardiovascular disease prevention
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Received 12 Jan, 2021
Editorial decision: Minor revision
On 12 Jan, 2021
Reviewer #3 agreed
On 22 Dec, 2020
Reviewer #2 agreed
On 17 Dec, 2020
Review #1 received
Received 27 Nov, 2020
Editor assigned
On 25 Nov, 2020
Reviewers invited
Invitations sent on 25 Nov, 2020
Reviewer #1 agreed
On 25 Nov, 2020
Submission checks complete
On 25 Nov, 2020
Editor invited
On 25 Nov, 2020
Version 1
Posted 12 Aug, 2020
No comments provided
Editorial decision: Revise before peer review
On 26 Aug, 2020
Editor assigned
On 11 Aug, 2020
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On 10 Aug, 2020
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On 10 Aug, 2020
First submitted
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Subject Areas
Health Economics & Outcomes Research
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at Implementation Science Communications.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Short report
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Implementation Science Communications.
No community comments so far
Editor assigned
On 21 Jan, 2021
Submission checks complete
On 21 Jan, 2021
Editor invited
On 21 Jan, 2021
No comments provided
Review #2 received
Received 12 Jan, 2021
Editorial decision: Minor revision
On 12 Jan, 2021
Reviewer #3 agreed
On 22 Dec, 2020
Reviewer #2 agreed
On 17 Dec, 2020
Review #1 received
Received 27 Nov, 2020
Editor assigned
On 25 Nov, 2020
Reviewers invited
Invitations sent on 25 Nov, 2020
Reviewer #1 agreed
On 25 Nov, 2020
Submission checks complete
On 25 Nov, 2020
Editor invited
On 25 Nov, 2020
Version 1
Posted 12 Aug, 2020
No comments provided
Editorial decision: Revise before peer review
On 26 Aug, 2020
Editor assigned
On 11 Aug, 2020
Submission checks complete
On 10 Aug, 2020
Editor invited
On 10 Aug, 2020
First submitted
On 07 Aug, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Health Economics & Outcomes Research
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Implementation Science Communications.
Background. A stepped-wedge, cluster randomized controlled trial assessed the effectiveness of practice facilitation (PF) for adoption of guidelines for prevention and treatment of cardiovascular disease risk factors. This study estimated the associated cost of PF for guideline adoption in small, private primary care practices.
Methods. The cost analysis included categories for start-up costs, intervention costs, and practice staff costs for the implemented PF-guided intervention. We estimated the total one-year costs to operate the program, and calculated the mean and range of the cost-per-practice by quarter of the intervention. We estimated the lower and upper bounds for all salary expenses, rounding to the nearest $100.
Results. Total one-year intervention costs for all 261 practices ranged from $7,900,000-$10,200,000, with program and practice salaries comprising $6,600,000-$8,400,000 of the total. Start-up costs were a small proportion (3%) of total one-year costs. Excluding start-up costs, quarter 1 cost-per-practice was the most expensive at $20,400-$26,700, and quarter 4 was least expensive at about $10,000. Practice staff time (compared with program staff time) was the majority of the staffing costs at 75-84%.
Conclusions. The PF strategy cost approximately $10,000 per practice per quarter for program and practice costs, once implemented and running at highest efficiency. Whether this program is “worth it” to the decision-maker depends on the relative costs and effectiveness of their other options for improving cardiovascular risk reduction.
Trial Registration. This study is retrospectively registered on January 5, 2016 at www.clinicaltrials.gov as NCT02646488. https://clinicaltrials.gov/ct2/show/NCT02646488
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