Using Budget Impact Analysis to Assess the Costs of Implementing Prevention Interventions

Background. While the long-term cost-effectiveness of prevention interventions is often unknown, another notable barrier to adoption of effective prevention interventions is the uncertainty surrounding the short-term costs of implementation. Budget impact analysis (BIA) is an economic evaluation methodology that is used to measure and analyze the short- to medium-term financial consequences of introducing a new intervention or technology, including the costs of implementation. There has been limited use of BIA in implementation and dissemination projects, largely because the methodology is still evolving, and expertise is limited.

OBJECTIVE: To describe the strengths and limitations of the existing methodological base for using BIA methods to assess the costs of implementing prevention interventions. 

METHODS: We conducted an electronic search on PubMed to identify published BIAs in the United States Department of Veterans Affairs and outside sources. Twenty-three studies met the inclusion criteria. Using the most recent methodological recommendations for developing and reviewing BIAs (Sullivan et al., 2014), we constructed a BIA review template which was divided into three main sections: 1) analytic framework, 2) inputs and data sources, and 3) reporting format. The template also included a section regarding the inclusion of implementation costs. We utilized this template to evaluate the 23 studies for inclusion of recommended BIA elements. Two authors independently assessed studies for inclusion of various BIA elements and then collaboratively to discuss and resolve discrepancies.

FINDINGS: The ISPOR 2012 Budget Impact Analysis Good Practice II Task Force Report provides a useful framework for conducting BIA for implementation of prevention interventions.  In particular, several components of BIA, including scenario analysis and the development of spreadsheet-based cost calculators, are especially well suited for simulation- or model-based evaluations of prevention interventions. However, neither the framework nor other existing literature provides explicit guidance for capturing implementation-specific costs. Also, no methods exist for assessing the budget impact of de-implementation.

IMPACT: Additional development of BIA methods for implementation research would facilitate greater use of these methods in assessing the short-term costs associated with implementing prevention interventions and provide additional critical information to consumers of prevention research.