Costing implementation strategies (Cost-IS)
Cost-IS is an instrument for costing implementation strategies in the healthcare setting.
Cost-IS’s aim and scope is to collect data on the costs associated with implementation strategies for healthcare interventions. The instrument provides a pragmatic and flexible approach that can be tailored to meet the needs of various projects.
Reliable implementation cost estimations produced from this standardised tool will inform appropriate resourcing for implementation strategies resulting in a greater likelihood of implementation success. As well as providing decision makers with reliable information from economic evaluations of health care innovations that account for the full extent of costs. It is anticipated that the transdisciplinary nature of Cost-IS will contribute to an expanded knowledge of implementation costs through improved collaboration between implementation scientists and health economists. Further piloting of Cost-IS is required for validation.
Cost-IS Templates
Cost-IS comprises of three data collection templates: template 1, 2, and 3.
Analysis
Cost-IS is a data collection tool. Subsequent analysis from the data collected in the completed templates should be conducted in a meaningful way to the project as determined by the analyst. The templates were designed to collect data at varying levels of detail because of the wide range of implementation projects.
A worked example of Cost-IS is provided below which may assist future users of Cost-IS. An additional user guide was produced as a result of applying Cost-IS to three real-world implementation projects as case studies (manuscript coming soon). The completed Cost-IS templates from the collective case study are provided as another example that may assist future users.
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Worked example explained by template
The worked example of template 1 includes four implementation strategies with associated activities and resources. Both labour and non-labour resources are included under the corresponding column and respective strategy.
In template 2 the entries columns ‘Activity’, ‘Strategy’ and ‘Role’ are restricted by drop down menus containing what was listed in template 1. Template 1 can be completed iteratively as required by the project.
In the worked example of template 2A, all activities associated with the hypothetical implementation were recorded. The date, site and phase for each activity is recorded under the corresponding columns. Similarly, a purpose was recorded for each activity to distinguish it from other similar activities. The implementation strategy related to the respective activity was documented in the same row.
The cost is automatically calculated under the respective column when the resource, number of resource, and time spent by resource is completed. See below for how labour and non-labour resources were recorded.
The source where this data was collected from is recorded in the final column.
labour resource
Project roles involved in the activity are documented under the ‘resource’ column. The resource category is taken by the information provided in Template 3. Unique project roles are recorded on a separate row and the activity is repeated. For each activity, the number of personnel and the time spent (in hours) for each project role was recorded under the corresponding column. The resource is described as labour under the corresponding column.
non-labour resource
The worked example contains two non-labour resources used in the hypothetical implementation. The activity associated with non-labour resources are recorded in Template 2 in a similar manner as described above. The unit price is taken from information provided in Template 3. The number of units per resource is recorded under ‘number of personnel involved’. The resource is described as non-labour under the corresponding column.
Each unique resource is listed in Template 3. The entries in column ‘resource’ is restricted by a drop down menu containing what was listed in template 1. Template 1 can be completed iteratively as required by the project.
labour resource
Labour resources are listed as project roles. A resource category relevant to the project is applied to each role for granular analysis. The role’s position/ tile and annual salary is provided in the following columns. The hourly cost and hourly plus oncosts is automatically calcualted in the next columns. Adapt the number of hours and oncosts as required to your project.
non-labour resource
The worked example contains two non-labour resources used in the hypothetical implementation. Non-labour resources are listed in the bottom section of Template 3. A resource category is still applied to non-labour resources. In the next column, the resource is listed as a monetary or opportunity cost type. The source, cost year, and unit price are supplied in the following columns.
The worked example demonstrates how implementation costs can be summarised by resource and implementation strategy. An example of how implementation cost findings may be presented are below.
Cost-IS was developed iteratively across four phases.
Phase 1 involved a systematic literature review to identify the nature of implementation costs and the methods used to measure and value these costs, within the context of hospital-based clinical decision support systems initiatives.
Phase 2 consisted of qualitative semi-structured interviews that outlined current practices for capturing the costs associated with implementing digital health initiatives in hospital settings.
Phase 3 development involved a modified electronic-Delphi (e-Delphi) process to generate a consensus on the core components and design of an implementation costing instrument.
In Phase 4 the developed Cost-IS was applied to three real-world implementation projects in a collective case study.
Development papers
Read more about the development of Cost-IS in the following papers
Phase 3 Preprint
Phase 4 Preprint
Future development
Cost-IS requires further validation including applying Cost-IS from the beginning of new projects to guide prospective collection of implementation costs. Prospective data collection may allow more comprehensive and accurate data to be collected throughout the project and may reduce the reliance on informed assumptions and recall.
Investigation into incorporating contextual information with implementation cost estimates will improve Cost-IS and was a suggestion from Phase 4. The inclusion of contextual information will improve transparency of implementation cost estimates.
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Please cite the relevant journal article when referring to Cost-IS. We recommend this article.
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