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Table 2 Economic Evaluation Types with Descriptions and Examples from the TFCO Case Study

From: Using economic evaluations in implementation science to increase transparency in costs and outcomes for organizational decision-makers

Economic Evaluation Type

Description

Outcome type

Example Perspective

Example Description (using TFCO)

Return-On-Investment Analysis

A direct analysis of the level of returns projected for a specific investment, relative to the cost of that investment

Ratio of gain/loss relative to cost

Narrow – organizational decision-maker

To determine the likelihood of sustainment, calculate the estimated costs for full implementation and project the number of patients needed to recoup those costs

Budget Impact Analysis

Narrow analysis of the impact of a program on the budget of a specific payer. Does not take into account the broader costs or benefits to a larger social system or to society

Financial impact on a specific payer

Narrow – organizational decision-maker

An organization that is interested in implementing TFCO can project the specific costs related to implementation and the intervention itself using previous estimates collected with COINS, then calculate the projected financial returns from Medicaid and foster care placement billing

Cost-benefit

All costs and benefits translated into financial terms. Could include costs and benefits at the societal or broader system scale. However, not often used in health or social service research because it can be challenging (and controversial) to translate human life outcomes into monetary terms

All outcomes measured in monetary terms

Broad – Systems perspective (social services)

Although the implementing organization may recoup costs directly through billing, other cost-savings may occur across the social service systems. A cost-benefit analysis could estimate the cost savings related to lower levels/intensity of crime, recidivism, and behavioral health treatment for the patients of TFCO.

Cost-effectiveness

Estimating the costs spent to increase one unit of health or social outcome. Usually considers the broader society or health/social service system rather than just one payer

Units of health or social outcome such as years of life saved or fidelity score

Narrow – organizational decision-maker

For IND and CDT, there are risk probabilities of implementation failure at each step of the SIC process which map onto different likely costs. If an organizational decision-maker is only willing to risk a certain amount of sunk costs, cost-effectiveness analysis using a decision-tree could help them understand which implementation strategy (IND or CDT) is less likely to exceed that threshold (see Appendix A for decision tree example).

In implementation science, relevant health outcomes include adoption, fidelity scores, patient reach, penetration, and sustainment

Cost-utility

Similar to cost-effectiveness, but a more specific analysis that summarizes health outcomes into both mortality and morbidity.

Units of health or social outcome accounting for quality of life (such as Quality Adjusted Life Years (QALYs))

Broad - Systems and Societal

An evaluation of both the implementation approaches (CDT vs. IND) and the intervention, TFCO, itself would include both implementation outcomes such as reach and penetration as well as patient outcomes such as youth recidivism, delinquency, internalizing symptoms, deviant peer relations, psychological symptoms, and unplanned pregnancies