Carlos is now focused on contributing to a broad range of applied health research projects at NIHR Applied Research Collaboration (ARC) West in collaborations between academia, the NHS and other partners. A recent focus of his work is related to bringing evidence into practice and behaviour change interventions. He is also part of the Health Economics Bristol (HEB) at Bristol Medical School.
Before joining ARC, Carlos completed my PhD (finished in 2020) in behavioural economics and experimental psychology. Particularly, he studied the impact of labelling interventions in tobacco and alcohol products.
He use a wide range of methodologies including experimental techniques, cost-effectiveness analysis, decision analysis models or qualitative analyses in multidisciplinary fields. Always orientated in promoting common good: consumerism, public health interventions, harm reduction, mental health, and behaviour change in general.
Carlos is also interested in public and policy engagement and consider it as an important aspect of his work. He also have some experience in teaching and supervising students. He teaches health economics on the Master course in Public Health and NIHR ARC West training course on Health Economics.
Background: methods for the economic evaluation of implementation initiatives to increase the uptake of cost-effective healthcare interventions are not standardised. Value of implementation and policy cost-effectiveness are two proposed approaches. This research aims to demonstrate that these are mathematically equivalent and propose a standardised approach. To illustrate this, we evaluated two implementation programmes to increase magnesium sulphate uptake in preterm labour to reduce the risk of cerebral palsy: i) the National PReCePT Programme (NPP) which provided support and funded clinical time in maternity units in England, and ii) the PReCePT enhanced support model (ESP), which was nested within NPP in a cluster RCT.
Methods: after summarising value of implementation and policy cost-effectiveness approaches, we show that they are mathematically equivalent, and propose a standardised stepwise method. We apply this method to the NPP (versus pre-existing trends) and the ESP (versus the NPP) calculating incremental cost-effectiveness ratios, net monetary benefits, and probabilities of being cost-effective.
Results: estimating the cost-effectiveness of implementation programmes depends on the change in the healthcare technology uptake, cost of the implementation, size of the eligible population, and the cost-effectiveness of the healthcare technology. With our standardised stepwise analysis approach, the NPP cost £6,044 to implement per maternity unit and generated a societal lifetime net monetary benefit of £30,247 per unit over 12 months, at a willingness-to-pay threshold of £20,000; the probability of being cost-effective was 98%. In contrast, the ESP cost £16,869 to implement per unit and generated a net monetary benefit of -£28,682 per maternity unit in comparison to the NPP; the probability of being cost-effective was 22%.
Conclusions: our standardised stepwise method enables the economic evaluation of implementation initiatives and is useful for implementation research. In this case, the NPP was highly cost-effective, but the addition of enhanced support was unlikely to be cost-effective.