Costing out interventions in D & I Research

1. Costing out interventions in D & I Research Tzeyu Michaud, PhD Department of Health Promotion, UNMC tzeyu.michaud@unmc.edu

2. Overview • Role of costs in dissemination & implementation research • Principle of costing • Cost data collection guide • Example/ template

3. Role of Costs in D & I Research • High-cost intervention was created to achieve large effect size • Costs are critical to ensuing broad-scale adoption & implementation • Increase intervention impact by maximizing reach and adoption • Cost data should be published to facilitate the development of more realistic and scalable interventions

4. Principle of Costing

5. Intervention Type

6. Type of Perspective Societal Healthcare sector Payers Clinic, worksite, & local community group (small organization) Clinicians and implementing staff Participant/family

7. General Perspective

8. Implementation Perspective Rhodes, Jones, et al. "Stakeholder perspectives on costs and resource expenditures: tools for addressing economic issues most relevant to patients, providers, and clinics." Translational behavioral medicine (2018).

9. What Costs to be included? • Research • Grant administration • Acquisition of IRB approval • Timing administering & analyzing assessments • Manuscript preparation • Development • Protocol • Website design • Telephone script production • Others (i.e. Newsletter of handout) • Recruitment • Intervention/Implementation Intervention Costs

10. Treatment & Preventive Treatment • Key Intervention component • Diagnostic & investigational procedures • Acquisition & administration cost of treatment • Health professional services • Patient support and care • Marketing & Media costs • Identification and participation of target population • Personnel costs (if not included yet) • Overhead (i.e., utilities & facilities) • Intervention-specific equipment

11. Screening & Health Promotion • Intervention component • Advice, consultations, care/services, products, • Screening kits and sample testing (if applicable) • Communication of results/progress • Marketing & Media costs • Identification & enrollment of eligible participants • Recruitment & training providers • Referral (and possible treatment) of identified cases of disease • Ongoing monitoring of program performance

12. Regulatory & Policy • Cost of passing a statute or regulation • Marketing and media costs • Enforcement costs • Evaluation or monitoring of outcomes

13. Target population (3,234 participants) With impaired glucose tolerance 25 years of age & older BMI ≥24 kg/m2 Intervention arm Lifestyle change: 16 lessons in the first 24 weeks, and then every 2 months meet with case managers with at least 1 phone call between visits Metformin:  850 mg of metformin twice a day Placebo: took a placebo twice a day Cost categories Direct medical costs Direct non-medical costs Indirect costs Diabetes Prevention Program Research Group. "Costs associated with the primary prevention of type 2 diabetes mellitus in the diabetes prevention program." Diabetes care26.1 (2003): 36-47.

14. Direct Medical Costs

15. Other Costs Direct non-medical costs Participant time Study visits Leisure-time PA Shopping & cooking Purchase of service Exercise class Health club personal trainer Weigh loss class Fitness equipment Food equipment Shoes Food Transportation Indirect cost (productivity loss) Morbidity loss Mortality loss

16. Template- Treatment Perspective:__________

17. Target population (320 participants) Aged 18 and older Smoked ten or more cigarettes per day Study arm Intervention: four telephone counseling sessions, four tailored newsletters, and one targeted newsletter. Usual care:  generic health education mailings Ritzwoller, Debra P., et al. "Costing behavioral interventions: a practical guide to enhance translation." Annals of Behavioral Medicine 37.2 (2009): 218-227.

18. Cost Components Fixed costs Facilities (office space) Equipment/ technology Variable Costs Personnel & other labor Supplies Building operating & maintenance Training & education Administrative Operating Ritzwoller, Debra P., et al. "Costing behavioral interventions: a practical guide to enhance translation." Annals of Behavioral Medicine 37.2 (2009): 218-227.

19. Template- Health Promotion Program Perspective:__________

20. Source of Data Collection Administrative data base Survey for providers and beneficiaries Observational studies Expert panel Published price list (e.g. average wholesale price) Published literature Others

21. Summary Plan ahead (study design) Identify intervention type & perspective Ask for help