Thomasina Donovan is a PhD candidate from Brisbane, Australia. She is studying within the Australian Centre for Health Services Innovation (AusHSI) in the School of Public Health and Social Work, Faculty of Health at the Queensland University of Technology (QUT). Her PhD aims to combine knowledge from health economics and implementation science to develop an implementation costing instrument. She is conducting this research within the digital health field and has investigated the implementation of computerised decision support systems (CDSS). Prior to her PhD, Thomasina worked in cellular and molecular biology, particularly epigenetics, in the fields of oncology and exercise science.
Economic evaluations determine the relative value for money of health innovations and are important for decision makers when allocating scarce resources. However, implementation strategies require additional resourcing which is typically not accounted for in published economic evaluations. This study sought to understand current practices for capturing the costs associated with implementing digital health initiatives in hospital settings, where the complexities of technology and systems present unique challenges for implementation efforts.
A qualitative study of semi-structured interviews with 16 purposively sampled experts in implementation science, health economics and/or digital health was conducted. The interview guide was informed by a literature review and was pilot tested. Interviews were digitally recorded and transcribed. A hybrid inductive/deductive framework analysis was conducted using thematic analysis to elicit key concepts related to the research question.
Interviews were conducted with eight implementation scientists, six health economists, and eleven digital health specialists. Four participants were experienced in more than one field. Five key themes were elicited from the data: types of costs, why implementation is costed, how to cost implementation, implementation phases, and barriers and enablers to costing implementation. Broadly, interviewees recognised implementation costs as important but only some costs were considered in practice due to inconsistencies in terminology and the perceived ill-defined boundaries of implementation. Implementation costs were typically recorded to support the delivery of high value care. A variety of methods were used to collect and analyse implementation costs in practice. Multidisciplinary collaboration facilitated this process, but the burden of collecting the necessary data was highlighted.
Understanding current practices for capturing implementation costs of digital health initiatives provides opportunities to improve practice and progress research in this space. Ongoing research should establish appropriate methodology for costing implementation efforts within digital health, and healthcare settings more broadly.