1. Costing out interventions in D & I Research
Tzeyu Michaud, PhD
Department of Health Promotion, UNMC

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 Type Example Treatment Pharmaceuticals
Prophylactic treatment
Aspirin
Diagnostics
Changes in diagnostic protocols with introduction of new treatments
Screening program
Colorectal cancer screening
Delivery of service
Care coordinator
Health Promotion program
Weight management program
Regulatory/ policy
Sugar-sweetened beverage tax.; alcohol & tobacco tax
Marketing/ education campaigns
Health promotion (exercise, diet)

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

7. General Perspective cost components/perspective Societal
Healthcare sector
Payers
Direct medical costs
paid by payers
Yes
out-of-pocket No
Direct non-medical costs (e.g. transportation, unpaid caregiving time, or patient time)
Indirect costs (e.g. loss of productivity)

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):

14. Direct Medical Costs Lifestyle change Metformin Placebo
Baseline history & physical exam
Exercise test
Core curriculum & materials
Supervised activity sessions
Group sessions
In-person visit
Phone calls & reminder phone calls
Overhead
Standard life style recommendation
Lab
Venipuncture
Serum creatinine
Hemoglobin/hematocrit
Urine creatinine
Follow-up visit
Dose-titration/restart visits
Annual visit
Materials

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. Direct non-medical Costs
Template- Treatment
Perspective:__________
Study arm/Cost category
Direct Medical Costs
Direct non-medical Costs
Indirect Costs
Intervention A
Intervention B
etc.

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):

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):

19. Template- Health Promotion Program
Perspective:__________
Project phase/Cost category
Fixed Costs
Variable Costs
Research
Development
Recruitment
Intervention/Implementation

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