Economic evaluation of implementation science outcomes in low- and middle-income countries: a scoping review

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dc.contributor.authorMalhotra, Akash-
dc.contributor.authorThompson, Ryan R.-
dc.contributor.authorKagoya, Faith-
dc.contributor.authorMasiye, Felix-
dc.contributor.authorMbewe, Peter-
dc.contributor.authorMosepele, Mosepele-
dc.contributor.authorPhiri, Jane-
dc.contributor.authorSambo, Jairos-
dc.contributor.authorBarker, Abigail-
dc.contributor.authorCameron, Drew B.-
dc.contributor.authorDavila-Roman, Victor G.-
dc.contributor.authorEffah, William-
dc.contributor.authorHutchinson, Brian-
dc.contributor.authorLaxy, Michael-
dc.contributor.authorNewsome, Brad-
dc.contributor.authorWatkins, David-
dc.contributor.authorSohn, Hojoon-
dc.contributor.authorDowdy, David W.-
dc.identifier.citationImplementation Science. 2022 Nov 16;17(1):76ko_KR
Historically, the focus of cost-effectiveness analyses has been on the costs to operate and deliver interventions after their initial design and launch. The costs related to design and implementation of interventions have often been omitted. Ignoring these costs leads to an underestimation of the true price of interventions and biases economic analyses toward favoring new interventions. This is especially true in low- and middle-income countries (LMICs), where implementation may require substantial up-front investment. This scoping review was conducted to explore the topics, depth, and availability of scientific literature on integrating implementation science into economic evaluations of health interventions in LMICs.

We searched Web of Science and PubMed for papers published between January 1, 2010, and December 31, 2021, that included components of both implementation science and economic evaluation. Studies from LMICs were prioritized for review, but papers from high-income countries were included if their methodology/findings were relevant to LMIC settings.

Six thousand nine hundred eighty-six studies were screened, of which 55 were included in full-text review and 23 selected for inclusion and data extraction. Most papers were theoretical, though some focused on a single disease or disease subset, including: mental health (n = 5), HIV (n = 3), tuberculosis (n = 3), and diabetes (n = 2). Manuscripts included a mix of methodology papers, empirical studies, and other (e.g., narrative) reviews. Authorship of the included literature was skewed toward high-income settings, with 22 of the 23 papers featuring first and senior authors from high-income countries. Of nine empirical studies included, no consistent implementation cost outcomes were measured, and only four could be mapped to an existing costing or implementation framework. There was also substantial heterogeneity across studies in how implementation costs were defined, and the methods used to collect them.

A sparse but growing literature explores the intersection of implementation science and economic evaluation. Key needs include more research in LMICs, greater consensus on the definition of implementation costs, standardized methods to collect such costs, and identifying outcomes of greatest relevance. Addressing these gaps will result in stronger links between implementation science and economic evaluation and will create more robust and accurate estimates of intervention costs.

Trial registration
The protocol for this manuscript was published on the Open Science Framework. It is available at:

(DOI: 10.17605/OSF.IO/32EPJ).
dc.description.sponsorshipImplementation Research Strategies for Heart, Lung, and Blood Co-morbidities in People Living with HIV-Research Coordinating Center-1U24HL154426-01. Integrating Hypertension and Cardiovascular Disease Care into Existing HIV Service Package in Botswana (InterCARE)-1UG3HL154499-01. Scaling Out and Scaling Up the Systems Analysis and Improvement Approach to Optimize the Hypertension Diagnosis and Care Cascade for HIV-infected Individuals (SCALE SAIA HTN)-1UG3HL156390-01.
Integrating HIV and hEART health in South Africa (iHeart-SA)-1UG3HL156388-01. PULESA-UGANDA-Strengthening the Blood Pressure Care and Treatment cascade for Ugandans living with HIV-ImpLEmentation Strategies to SAve lives-1UG3HL154501-01.
Application of Implementation Science approaches to assess the efectiveness of Task-shifted WHO-PEN to address cardio Metabolic complications in people living with HIV in Zambia-1UG3HL156389-01. The funders had no role in the design of the study, the collection, analysis, and interpretation of data, or in the writing of the manuscript.
dc.subjectEconomic evaluation-
dc.subjectImplementation science-
dc.subjectImplementation outcomes-
dc.subjectLow- and middle-income countries-
dc.subjectInfectious disease-
dc.subjectScoping review-
dc.titleEconomic evaluation of implementation science outcomes in low- and middle-income countries: a scoping reviewko_KR
dc.citation.journaltitleImplementation Scienceko_KR
dc.rights.holderThe Author(s)-
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College of Medicine/School of Medicine (의과대학/대학원)Preventive Medicine (예방의학전공)Journal Papers (저널논문_예방의학전공)
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