University of Oulu

Falkenbach, P., Raudasoja, A.J., Vernooij, R.W.M. et al. Reporting of costs and economic impacts in randomized trials of de-implementation interventions for low-value care: a systematic scoping review. Implementation Sci 18, 36 (2023).

Reporting of costs and economic impacts in randomized trials of de-implementation interventions for low-value care : a systematic scoping review

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Author: Falkenbach, Petra1; Raudasoja, Aleksi J.2; Vernooij, Robin W. M.3,4;
Organizations: 1Finnish Coordinating Center for Health Technology Assessment, Oulu University Hospital, University of Oulu, Oulu, Finland
2Finnish Medical Society Duodecim, Faculty of Medicine, University of Helsinki, Helsinki, Finland
3Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
4Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
5Mehiläinen Oy, Helsinki, Finland
6Department of Medicine, Division of General Internal Medicine, McMaster University, Hamilton, ON, Canada
7Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
8Department of Urology, University of Fukui Faculty of Medical Sciences, Fukui, Japan
9Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
10Department of Gynaecology, Chelsea and Westminster NHS Foundation Trust, London, UK
11Department of Surgery, Division of Urology/Uro-Oncology, School of Medicine, Universidad del Valle, Cali, Colombia
12Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
13Department of Radiology, Faculty of Medicine and Health Technologies, Imaging Centre, Tampere University Hospital, Tampere University, Tampere, Finland
14Finnish Medical Society Duodecim, Helsinki, Finland
15Wellbeing Services County of Pirkanmaa, Unit of Health Sciences, Faculty of Social Sciences, Hatanpää Health Center, Tampere University, Tampere, Finland
16Department of Dentistry and Oral Health, Oral Health Care, Institute of Dentistry, Aarhus University, University of Eastern, Kuopio, Finland
17Division of Urology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
18Departments of Surgery and Health Research Methods Evidence and Impact, McMaster University, Hamilton, Canada
19Department of Surgery, South Karelian Central Hospital, Lappeenranta, Finland
20Oulu University Hospital, University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.6 MB)
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Language: English
Published: Springer Nature, 2023
Publish Date: 2023-10-23


Background: De-implementation of low-value care can increase health care sustainability. We evaluated the reporting of direct costs of de-implementation and subsequent change (increase or decrease) in health care costs in randomized trials of de-implementation research.

Methods: We searched MEDLINE and Scopus databases without any language restrictions up to May 2021. We conducted study screening and data extraction independently and in duplicate. We extracted information related to study characteristics, types and characteristics of interventions, de-implementation costs, and impacts on health care costs. We assessed risk of bias using a modified Cochrane risk-of-bias tool.

Results: We screened 10,733 articles, with 227 studies meeting the inclusion criteria, of which 50 included information on direct cost of de-implementation or impact of de-implementation on health care costs. Studies were mostly conducted in North America (36%) or Europe (32%) and in the primary care context (70%). The most common practice of interest was reduction in the use of antibiotics or other medications (74%). Most studies used education strategies (meetings, materials) (64%). Studies used either a single strategy (52%) or were multifaceted (48%). Of the 227 eligible studies, 18 (8%) reported on direct costs of the used de-implementation strategy; of which, 13 reported total costs, and 12 reported per unit costs (7 reported both). The costs of de-implementation strategies varied considerably. Of the 227 eligible studies, 43 (19%) reported on impact of de-implementation on health care costs. Health care costs decreased in 27 studies (63%), increased in 2 (5%), and were unchanged in 14 (33%).

Conclusion: De-implementation randomized controlled trials typically did not report direct costs of the de-implementation strategies (92%) or the impacts of de-implementation on health care costs (81%). Lack of cost information may limit the value of de-implementation trials to decision-makers.

Trial registration: OSF (Open Science Framework):

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Series: Implementation science
ISSN: 1748-5908
ISSN-E: 1748-5908
ISSN-L: 1748-5908
Volume: 18
Article number: 36
DOI: 10.1186/s13012-023-01290-3
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3141 Health care science
Funding: Open Access funding provided by University of Oulu including Oulu University Hospital. This research is funded by the Strategic Research Council (SRC) (numbers 335288, 336278, 336281). The funding source was not involved in the study design; collection, analysis, and interpretation of data; writing the report; nor in the decision to submit the article for publication.
Academy of Finland Grant Number: 335288
Detailed Information: 335288 (Academy of Finland Funding decision)
336278 (Academy of Finland Funding decision)
336281 (Academy of Finland Funding decision)
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