Skip to main content
SpringerLink
Log in

Systematic review of economic evaluations and cost analyses of guideline implementation strategies

  • Original paper
  • Published:
The European Journal of Health Economics Aims and scope Submit manuscript

Abstract

To appraise the quality of economic studies undertaken as part of evaluations of guideline implementation strategies, we conducted a systematic review of such studies published between 1966 and 1998. Studies were assessed against BMJ economic evaluations guidelines for each stage (guideline development, implementation and treatment). Of 235 studies identified, 63 reported some information on cost. Only 3 studies provided evidence that their guideline was effective and efficient, 38 reported treatment costs only, 12 implementation and treatment costs, 11 implementation costs alone, and 2 guideline development, implementation and treatment costs. No study gave reasonably complete information on costs. Thus, very few satisfactory economic evaluations of guideline implementation strategies have been performed. Current evaluations have numerous methodological defects and rarely consider all relevant costs and benefits. Future evaluations should focus on evaluating the implementation of evidence-based guidelines.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Institute of Medicine: Guidelines for Clinical Practice: From Development to use. National Academic Press, Washington (1992)

  2. Grimshaw, J.M., Russell, I.T.: Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet 342, 1317–1322 (1993)

    Article  Google Scholar 

  3. NHS Centre for Reviews and Dissemination and Nuffield Institute for Health. Implementing clinical guidelines: Can guidelines be used to improve clinical practice? Eff. Health Care 1, 1–12 (1994)

    Google Scholar 

  4. Oxman, A.D., Thomson, M.A., Davis, D.A., Haynes, R.B.: No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. CMAJ 153, 1423–1431 (1995)

    Google Scholar 

  5. Davis, D.A., Taylor-Vaisey, A.: Translating guidelines into practice. A systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines. CMAJ 157, 408–416 (1997)

    Google Scholar 

  6. Worrall, G., Chaulk, P., Freake, D.: The effects of clinical practice guidelines on patient outcomes in primary care: a systematic review. CMAJ 156, 1705–1712 (1997)

    Google Scholar 

  7. Wensing, M., Van der Weijden, T., Grol, R.: Implementing guidelines and innovations in general practice: which interventions are effective? Br. J. Gen. Pract. 48, 991–999 (1998)

    Google Scholar 

  8. Thomas, L., Cullum, N., McColl, E., Rousseau, N., Soutter, J., et al.: Guidelines in professions allied to medicine. Cochrane Database Syst. Rev. (1) (1999), Art. No.: CD000349. DOI: 10.1002/14651858.CD000349 (1999)

  9. Drummond, M., OBrien, B., Stoddart, G., Torrance, G.: Methods for Economic Evaluation of Health Care Programme, 2nd edn. Oxford University Press, New York (1997)

    Google Scholar 

  10. McIntosh, E.: Economic evaluation of guideline implementation studies. In: Thorsen, T., Makela, M. (eds.) Changing Professional Practice: Theory and Practice of Clinical Guidelines Implementation. Danish Institute for Health Services Research, Copenhagen (1999)

  11. Mason, J., Wood, J., Freemantle, N.: Designing evaluations of interventions to change professional practice. J. Health Serv. Res. Policy 4, 106–111 (1999)

    Google Scholar 

  12. Mason, J., Freemantle, N., Nazareth, I., Eccles, M., Haines, A., Drummond, M.: When is it cost-effective to change the behaviour of health professionals. JAMA 286, 2988–2992 (2001)

    Article  Google Scholar 

  13. Grimshaw, J., Thomas, R., MacLennan, G., Fraser, C., Ramsay, C., et al.: Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol. Assess. 8(6) (2004)

  14. Bero, L.A., Grilli, R., Grimshaw, J.M., Mowatt, G., Oxman, A.D., et al. (eds.): The Cochrane Effective Practice and Organisation of Care Group (EPOC). In: The Cochrane Library, issue 1. Oxford: Update Software. Updated quarterly (2002)

  15. Drummond, M., Jefferson, T.: For the BMJ Working Party on guidelines for authors and peer-reviewers of economic submissions to the British Medical Journal Guidelines for authors and peer-reviewers of economic submissions to the British Medical Journal. BMJ 313, 275–283 (1996)

    Google Scholar 

  16. Carney, P.A., Dietrich, A.J., Keller, A., Landgraf, J., O’Connor, G.T.: Tools, teamwork, and tenacity: an office system for cancer prevention. J. Fam. Pract. 35, 388–394 (1992)

    Google Scholar 

  17. Leviton, L.C., Goldenberg, R.L., Baker, C.S., Schwartz, R.M., Freda, M.C., et al.: Methods to encourage the use of antenatal corticosteroid therapy for fetal maturation: a randomized controlled trial. JAMA 281, 46–52 (1999)

    Article  Google Scholar 

  18. Anonymous: Integrated care for diabetes: clinical, psychosocial and economic evaluation. Diabetes Integrated Care Evaluation Team. BMJ 308, 1208–1212 (1994)

    Google Scholar 

  19. Morrissey, J.P., Harris, R.P., Kincade-Norburn, J., McLaughlin, C., Garrett, J.M., et al.: Medicare reimbursement for preventive care. Changes in performance of services, quality of life, and health care costs. Med. Care 33, 315–331 (1995)

    Article  Google Scholar 

  20. Pearce, M.J., Begg, E.J.: Encouraging consensus cost effective drug therapy: five years experience with a hospital drug utilisation review programme. N. Z. Med. J. 110, 92–95 (1997)

    Google Scholar 

  21. van Walraven, C., Goel, V., Chan, B.: Effect of population-based interventions on laboratory utilization: a time-series analysis. JAMA 280, 2028–2033 (1998)

    Article  Google Scholar 

  22. Avorn, J., Soumerai, S.B., Taylor, W., Wessels, M.R., Janousek, J., et al.: Reduction of incorrect antibiotic dosing through a structured educational order form. Arch. Intern. Med. 148, 1720–1724 (1988)

    Article  Google Scholar 

  23. Brady, W.J., Hissa, D.C., McConnell, M., Wones, R.G.: Should physicians perform their own quality assurance audits? J. Gen. Intern. Med. 3, 560–565 (1998)

    Article  Google Scholar 

  24. Kouides, R.W., Bennett, N.M., Lewis, B., Cappuccio, J.D., Barker, W.H., et al.: Performance-based physician reimbursement and influenza immunization rates in the elderly. The Primary-Care Physicians of Monroe County. Am. J. Prev. Med. 14, 89–95 (1998)

    Article  Google Scholar 

  25. Dranitsaris, G., Warr, D., Puodziunas, A.: A randomized trial of the effects of pharmacist intervention on the cost of antiemetic therapy with ondansetron. Support. Care Cancer 3, 183–189 (1995)

    Article  Google Scholar 

  26. MacCosbe, P.E., Gartenberg, G.: Modifying empiric antibiotic prescribing: experience with one strategy in a medical residency program. Hosp. Formul. 20, 986–999 (1985)

    Google Scholar 

  27. Thomas, R., Grimshaw, J., McClinton, S., McIntosh, E., Mollison, J., et al.: An evaluation of a guideline-based open-access urological investigation service (URGE). Final project report to Chief Scientist Office of Scottish Office Home and Health Department. HSRU, Aberdeen (1998)

  28. Barnett, G.O., Winickoff, M.D., Dorsey, M.D., Lurie, R.S.: Quality assurance through automated monitoring and concurrent feedback using a computer-based medical information system. Med. Care 16, 962–970 (1978)

    Article  Google Scholar 

  29. Watson, M.C.: The development, implementation and evaluation of prescribing guidelines in general practice. Ph.D. thesis (University of Bristol) (1998)

  30. Katon, W., Von Korff, M., Lin, E., Simon, G., Walker, E., et al.: Collaborative management to achieve depression treatment guidelines. J. Clin. Psychiatry 58, 20–23 (1997)

    Google Scholar 

  31. Weingarten, S.R., Riedinger, M.S., Conner, L., Lee, T.H., Hoffman, I., et al.: Practice guidelines and reminders to reduce duration of hospital stay for patients with chest pain. An interventional trial. Ann. Intern. Med. 120, 257–263 (1994)

    Google Scholar 

  32. Weingarten, S.R., Riedinger, M.S., Hobson, P., Noah, M.S., Johnson, B., et al.: Evaluation of a pneumonia practice guideline in an interventional trial. Am. J. Respir. Crit. Care Med. 153, 1110–1115 (1996)

    Google Scholar 

  33. Gurwitz, J.H., Noonan, J.P., Soumerai, S.B.: Reducing the use of H2-receptor antagonists in the long-term-care setting. J. Am. Geriatr. Soc. 40, 359–364 (1992)

    Google Scholar 

  34. Winickoff, R., Wilner, S., Neisuler, R., Barnett, G.: Limitations of provider interventions in hypertension quality assurance. Am. J. Public Health 75, 43–46 (1985)

    Article  Google Scholar 

  35. Rosser, W.W., McDowell, I., Newell, C.: Use of reminders for preventive procedures in family medicine. CMAJ 145, 807–814 (1991)

    Google Scholar 

  36. Jefferson, T., Demicheli, V., Vale, L.: Methodological reviews of economic evaluations in health care. JAMA 287, 2809–2812 (2002)

    Article  Google Scholar 

  37. Fergusson, D., van Walraven, C., Coyle, D., Laupacis, A.: Economic evaluations of technologies to minimize perioperative transfusion: a systematic review of published studies. International Study of Peri-operative Transfusion (ISPOT) investigators. Transfus. Med. Rev. 2, 106–117 (1999)

    Article  Google Scholar 

  38. Dempsey, C.L.: Nursing home-acquired pneumonia: outcomes from a clinical process improvement program. Pharmacotherapy 15 (1 Pt 2), 33S–38S (1995)

    Google Scholar 

  39. Jones, D.L., Kroenke, K., Landry, F.J., Tomich, D.J., Ferrel, R.J.: Cost savings using a stepped-care prescribing protocol for nonsteroidal anti-inflammatory drugs. JAMA 275, 926–930 (1996)

    Article  Google Scholar 

  40. Morrison, J.C., Sumrall, D.D., Chevalier, S.P., Robinson, S.V., Morrison, F.S., Wiser, W.L.: The effect of provider education on blood utilization practices. Am. J. Obstet. Gynecol. 169, 1240–1245 (1993)

    Google Scholar 

  41. Shojania, K.G., Yokoe, D., Platt, R., Fiskio, J., Ma’luf, N., Bates, D.W.: Reducing vancomycin use utilizing a computer guideline: results of a randomized controlled trial. J. Am. Med. Inform. Assoc. 5, 554–562 (1998)

    Google Scholar 

  42. Suwangool, P., Moola-Or, P., Waiwatana, A., Sitthi-Amorn, C., Israsena, S., Hanvanich, M.: Effect of a selective restriction policy on antibiotic expenditure and use: an institutional model. J. Med. Assoc. Thai. 74, 272–275 (1991)

    Google Scholar 

  43. Williams, A.: The cost benefit approach. Br. Med. Bull. 30(3), 252–256 (1974)

    Google Scholar 

  44. Drummond, M., OBrien, B., Stoddart, G., Torrance, G.: Methods for Economic Evaluation of Health Care Programme, 1st edn. Oxford University Press, New York (1987)

    Google Scholar 

  45. Anonymous: The Guideline Development Process: 1 Information for the Public and the NHS. The National Institute for Clinical Excellence. Oaktree Press, London (2001)

  46. Truman, B.I., Smith-Akin, C.K., Hinman, A.R., Gebbie, K.M., Brownson, R., et al. and Task Force on Community Preventive Services: Developing the guide to community preventive services-overview and rationale. Am. J. Prev. Med. 18, 18–26 (2000)

    Google Scholar 

  47. Bloor, K., Freemantle, N., Khadjesari, Z., Maynard, A.: Impact of NICE guidance on laparoscopic surgery for inguinal hernias: analysis of interrupted time series. BMJ 326, 578 (2003)

    Article  Google Scholar 

  48. Sculpher, M.: Evaluating the cost-effectiveness of interventions designed to increase the utilisation of evidence-based guidelines. Fam. Pract. 17, S26–S31 (2000)

    Article  Google Scholar 

Download references

Acknowledgements

The work reported in this paper was part of a larger study funded by the UK NHS Research and Development, Health Technology Assessment Programme and would have not have possible without the work of Cynthia Fraser, Craig Ramsay, Paula Whitty, Martin Eccles, Lloyd Matowe, Liz Shirran, Michel Wensing, Rob Dikstra, Cam Donaldson and Allen Hutchison. We would also like to thank Liz Grant for the preparation of the final report, part of which forms the basis for this paper. The Health Services Research Unit and the Health Economics Research Unit are core funded by the Scottish Executive Health Department. The views expressed are those of the authors and not necessarily those of the funding bodies.

Author information

Authors and Affiliations

  1. Health Services Research Unit and Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland

    Luke Vale

  2. Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland

    Ruth Thomas & Graeme MacLennan

  3. Ottawa Health Research Institute, 725 Parkdale Ave, Ottawa, ON, K1Y 4E9, Canada

    Jeremy Grimshaw

Authors
  1. Luke Vale
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ruth Thomas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Graeme MacLennan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeremy Grimshaw
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luke Vale.

Additional information

Additional data for tables are available on request from the authors.

Appendix

Appendix

List of included studies

  1. 1.

    Anonymous: Integrated care for diabetes: clinical, psychosocial and economic evaluation. Diabetes Integrated Care Evaluation Team. BMJ 308, 1208–1212 (1994)

  2. 2.

    Avorn, J., Soumerai, S.B., Taylor, W., Wessels, M.R., Janousek, J., et al.: Reduction of incorrect antibiotic dosing through a structured educational order form. Arch. Intern. Med. 148, 1720–1724 (1988)

  3. 3.

    Banks, N.J., Palmer, R.H., Kane, N.M., Braun, O.P., Feldstein, M.L., et al.: Implementation and evaluation of a computerized reminder system in ambulatory care. Proc. Annu. Symp. Comput. Appl. Med. Care 12, 753–757 (1988)

  4. 4.

    Bareford, D., Hayling, A.: Inappropriate use of laboratory services: long term combined approach to modify request patterns. BMJ 301, 1305–1307 (1990)

  5. 5.

    Barnett, G.O., Winickoff, M.D., Dorsey, M.D., Lurie, R.S.: Quality assurance through automated monitoring and concurrent feedback using a computer-based medical information system. Med. Care 16, 962–970 (1978)

  6. 6.

    Belcher, D.W.: Implementing preventive services. Success and failure in an outpatient trial. Arch. Intern. Med. 150, 2533–2541 (1990)

  7. 7.

    Brady, W.J., Hissa, D.C., McConnell, M., Wones, R.G.: Should physicians perform their own quality assurance audits? J. Gen. Intern. Med. 3, 560–565 (1998)

  8. 8.

    Brufsky, J.W., Ross-Degnan, D., Calabrese, D., Gao, X., Soumerai, S.B.: Shifting physician prescribing to a preferred histamine-2-receptor antagonist. Effects of a multifactorial intervention in a mixed-model health maintenance organization. Med. Care 36, 321–332 (1988)

  9. 9.

    Bryce, F.P., Neville, R.G., Crombie, I.K., Clark, R.A., McKenzie, P.: Controlled trial of an audit facilitator in diagnosis and treatment of childhood asthma in general practice. BMJ 310, 838–842 (1995)

  10. 10.

    Kouides, R.W., Bennett, N.M., Lewis, B., Cappuccio, J.D., Barker, W.H., et al.: Performance-based physician reimbursement and influenza immunization rates in the elderly. The Primary-Care Physicians of Monroe County. Am. J. Prev. Med. 14, 89–95 (1998)

  11. 11.

    Carney, P.A., Dietrich, A.J., Keller, A., Landgraf, J., O’Connor, G.T.: Tools, teamwork, and tenacity: an office system for cancer prevention. J. Fam. Pract. 35, 388–394 (1992)

  12. 12.

    Lobach, D.F.: Electronically distributed, computer-generated, individualized feedback enhances the use of a computerized practice guideline. Proceedings/AMIA Annual Fall Symposium 493–497 (1996)

  13. 13.

    Clarke, J.A., Adams, J.E.: The application of clinical guidelines for skull radiography in the accident and emergency department: theory and practice. Clin. Radiol. 41, 152–155 (1990)

  14. 14.

    Del Mar, C.B., Green, A.C.: Aid to diagnosis of melanoma in primary medical care. BMJ 310, 492–495 (1995)

  15. 15.

    Dempsey, C.L.: Nursing home-acquired pneumonia: outcomes from a clinical process improvement program. Pharmacotherapy 15(1 Pt 2), 33S–38S (1995)

  16. 16.

    Dennis, C., Houston-Miller, N., Schwartz, R.G., Ahn, D.K., Kraemer, H.C., et al.: Early return to work after uncomplicated myocardial infarction. Results of a randomized trial. JAMA 260, 214–220 (1998)

  17. 17.

    Dranitsaris, G., Warr, D., Puodziunas, A.: A randomized trial of the effects of pharmacist intervention on the cost of antiemetic therapy with ondansetron. Support. Care Cancer 3, 183–189 (1995)

  18. 18.

    Evans, A.T., Rogers, L.Q., Peden, J.G. Jr, Seelig, C.B., Layne, R.D., et al.: Teaching dietary counselling skills to residents: patient and physician outcomes. The CADRE Study Group. Am. J. Prev. Med. 12, 259–265 (1996)

  19. 19.

    Everitt, D.E., Soumerai, S.B., Avorn, J., Klapholz, H., Wessels, M.: Changing surgical antimicrobial prophylaxis practices through education targeted at senior department leaders. Infect. Control Hosp. Epidemiol. 11, 578–583 (1990)

  20. 20.

    Feder, G., Griffiths, C., Highton, C., Eldridge, S., Spence, M., Southgate, L.: Do clinical guidelines introduced with practice based education improve care of asthmatic and diabetic patients? A randomised controlled trial in general practices in east London. BMJ 311, 1473–1478 (1995)

  21. 21.

    Frame, P.S., Zimmer, J.G., Werth, P.L., Hall, W.J., Eberly, S.W.: Computer-based vs manual health maintenance tracking. A controlled trial. Arch. Fam. Med. 3, 581–588 (1994)

  22. 22.

    Fraser, G.L., Wennberg, D.E., Dickens, J.D. Jr, Lambrew, C.T.: Changing physician behavior in ordering digoxin assays. Ann. Pharmacother. 30, 449–454 (1996)

  23. 23.

    Gortmaker, S.L., Bickford, A.F., Mathewson, H.O., Dumbaugh, K., Tirrell, P.C.: A successful experiment to reduce unnecessary laboratory use in a community hospital. Med. Care 26, 631–642 (1988)

  24. 24.

    Gurwitz, J.H., Noonan, J.P., Soumerai, S.B.: Reducing the use of H2-receptor antagonists in the long-term-care setting. J. Am. Geriatr. Soc. 40, 359–364 (1992)

  25. 25.

    Palmer, R.H., Hargraves, J.L.: Quality improvement among primary care practitioners: an overall appraisal of results of the Ambulatory Care Medical Audit Demonstration Project. Med. Care 34, SS102–SS113 (1996)

  26. 26.

    Herfindal, E.T., Bernstein, L.R., Kishi, D.T.: Effect of clinical pharmacy services on prescribing on an orthopedic unit. Am. J. Hosp. Pharm. 40, 1945–1951 (1983)

  27. 27.

    Hobbs, F.D., Delaney, B.C., Carson, A., Kenkre, J.E.: A prospective controlled trial of computerized decision support for lipid management in primary care. Fam. Pract. 13, 133–137 (1996)

  28. 28.

    Jones, D.L., Kroenke, K., Landry, F.J., Tomich, D.J., Ferrel, R.J.: Cost savings using a stepped-care prescribing protocol for nonsteroidal anti-inflammatory drugs. JAMA 275, 926–930 (1996)

  29. 29.

    Jones, R.H., Lydeard, S., Dunleavey, J.: Problems with implementing guidelines: a randomised controlled trial of consensus management of dyspepsia. Qual. Health Care 2, 217–222 (1993)

  30. 30.

    Katon, W., Von Korff, M., Lin, E., Simon, G., Walker, E., et al.: Collaborative management to achieve depression treatment guidelines. J. Clin. Psychiatry 58, 20–23 (1997)

  31. 31.

    Keyserling, T.C., Ammerman, A.S., Davis, C.E., Mok, M.C., Garrett, J., et al.: A randomized controlled trial of a physician-directed treatment program for low-income patients with high blood cholesterol: the Southeast Cholesterol Project. Arch. Fam. Med. 6, 135–145 (1997)

  32. 32.

    Kong, K.M., Johnson, W.F., Anderson, P.O., Sato, L.A., Simonian, R.I.: Effect of a pharmacy-based cost-containment program on cimetidine costs and use. Am. J. Hosp. Pharm. 44, 2068–2073 (1987)

  33. 33.

    Landefeld, C.S.: Guideline-based consultation to prevent anticoagulant related bleeding; randomized controlled trial in a teaching hospital. Ann. Intern. Med. 116, 829–837 (1992)

  34. 34.

    Landgren, F.T., Harvey, K.J., Mashford, M.L., Moulds, R.F., Guthrie, B., et al.: Changing antibiotic prescribing by educational marketing. Med. J. Aust. 149, 595–599 (1988)

  35. 35.

    Lee, T.H., Pearson, S.D., Johnson, P.A., Garcia, T.B., Weisberg, M.C., et al.: Failure of information as an intervention to modify clinical management. A time-series trial in patients with acute chest pain. Ann. Intern. Med. 122, 434–437 (1995)

  36. 36.

    Leviton, L.C., Goldenberg, R.L., Baker, C.S., Schwartz, R.M., Freda, M.C., et al.: Methods to encourage the use of antenatal corticosteroid therapy for fetal maturation: a randomized controlled trial. JAMA 281, 46–52 (1999)

  37. 37.

    MacCosbe, P.E., Gartenberg, G.: Modifying empiric antibiotic prescribing: experience with one strategy in a medical residency program. Hosp. Formul. 20, 986–999 (1985)

  38. 38.

    Marton, K., Tul, V., Sox, H.C. Jr: Modifying test-ordering behavior in the outpatient medical clinic. A controlled trial of two educational interventions. Arch. Intern. Med. 145, 816–821 (1985)

  39. 39.

    McDonald, C.J.: Use of a computer to detect and respond to clinical events: its effect on clinician behavior. Ann. Intern. Med. 84, 162–167 (1976)

  40. 40.

    Morgan, M., Studney, D.R., Barnett, G.O., Winickoff, R.N.: Computerized concurrent review of prenatal care. Qual. Rev. Bull. 4, 33–36 (1978)

  41. 41.

    Morrison, J.: Improving quality of referral: a cost effectiveness evaluation of clinical guidelines for infertility management across the interface. Final report to NHS Executive research and development programme, (1999)

  42. 42.

    Morrison, J.C., Sumrall, D.D., Chevalier, S.P., Robinson, S.V., Morrison, F.S., et al.: The effect of provider education on blood utilization practices. Am. J. Obstet. Gynecol. 169, 1240–1245 (1993)

  43. 43.

    Morrissey, J.P., Harris, R.P., Kincade-Norburn, J., McLaughlin, C., Garrett, J.M., et al.: Medicare reimbursement for preventive care. Changes in performance of services, quality of life, and health care costs. Med. Care 33, 315–331 (1995)

  44. 44.

    Nattinger, A.B., Panzer, R., Janus, J.: Improving the utilization of screening mammography in primary care practices. Arch. Intern. Med. 149, 2087–2092 (1989)

  45. 45.

    Onion, C.: Changes in medical practice following superficial and deep processing of evidence, a controlled experiment in clinical guidelines implementation. Thesis (Liverpool University) (1997)

  46. 46.

    Pearce, M.J., Begg, E.J.: Encouraging consensus cost effective drug therapy: five years experience with a hospital drug utilisation review programme. N. Z. Med. J. 110, 92–95 (1997)

  47. 47.

    Poma, P.: Effect of departmental policies on caesarean delivery rates: a community hospital experience. Obstet. Gynecol. 91, 1013–1018 (1998)

  48. 48.

    Raisch, D., Bootman, J., Larson, L., McGhan, W.: Improving antiulcer agent prescribing in a health maintenance organization. Am. J. Hosp. Pharm. 47, 1766–1773 (1990)

  49. 49.

    Rosser, W.W., McDowell, I., Newell, C.: Use of reminders for preventive procedures in family medicine. CMAJ 145, 807–814 (1991)

  50. 50.

    Shojania, K.G., Yokoe, D., Platt, R., Fiskio, J., Ma’luf, N., et al.: Reducing vancomycin use utilizing a computer guideline: results of a randomized controlled trial. J. Am. Med. Inform. Assoc. 5, 554–562 (1998)

  51. 51.

    Soumerai, S.B., Salem-Schatz, S., Avorn, J., Casteris, C.S., Ross-Degnan, D., et al.: A controlled trial of educational outreach to improve blood transfusion practice. JAMA 270, 961–966 (1993)

  52. 52.

    Stuart, M.E., Macuiba, J., Heidrich, F., Farrell, R.G., Braddick, M., et al.: Successful implementation of an evidence-based clinical practice guideline: acute dysuria/urgency in adult women. HMO Pract. 11, 150–157 (1997)

  53. 53.

    Suwangool, P., Moola-Or, P., Waiwatana, A., Sitthi-Amorn, C., Israsena, S., et al.: Effect of a selective restriction policy on antibiotic expenditure and use: an institutional model. J. Med. Assoc. Thai. 74, 272–275 (1991)

  54. 54.

    Thomas, J.C., Moore, A., Qualls, P.E.: The effect on cost of medical care for patients treated with an automated clinical audit system. J. Med. Syst. 7, 307–313 (1983)

  55. 55.

    van Walraven, C., Goel, V., Chan, B.: Effect of population-based interventions on laboratory utilization: a time-series analysis. JAMA 280, 2028–2033 (1998)

  56. 56.

    Watson, M.C.: The development, implementation and evaluation of prescribing guidelines in general practice. Ph.D. thesis (University of Bristol) (1998)

  57. 57.

    Weingarten, S., Ermann, B., Bolus, R., Riedinger, M.S., Rubin, H., et al.: Early “step-down” transfer of low-risk patients with chest pain. A controlled interventional trial. Ann. Intern. Med. 113, 283–289 (1990)

  58. 58.

    Weingarten, S.R., Riedinger, M.S., Conner, L., Lee, T.H., Hoffman, I., et al.: Practice guidelines and reminders to reduce duration of hospital stay for patients with chest pain. An interventional trial. Ann. Intern. Med. 120, 257–263 (1994)

  59. 59.

    Weingarten, S.R., Riedinger, M.S., Hobson, P., Noah, M.S., Johnson, B., et al.: Evaluation of a pneumonia practice guideline in an interventional trial. Am. J. Respir. Crit. Care Med. 153, 1110–1115 (1996)

  60. 60.

    Winickoff, R.N., Coltin, K.L., Morgan, M., Buxbaum, R., Barnett, G.: Improving physician performance through peer comparison feedback. Med. Care 22, 527–534 (1984)

  61. 61.

    Winickoff, R., Wilner, S., Neisuler, R., Barnett, G.: Limitations of provider interventions in hypertension quality assurance. Am. J. Public Health 75, 43–46 (1985)

  62. 62.

    Zehr, K., Dawson, P., Yang, S., Heitmiller, R.: Standardized clinical care pathways for major thoracic cases reduce hospital costs. Ann. Thorac. Surg. 66, 914–919 (1998)

  63. 63.

    Thomas, R., Grimshaw, J., McClinton, S., McIntosh, E., Mollison, J., et al.: An evaluation of a guideline-based open-access urological investigation service (URGE). Final project report to Chief Scientist Office of Scottish Office Home and Health Department. HSRU, Aberdeen (1998)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vale, L., Thomas, R., MacLennan, G. et al. Systematic review of economic evaluations and cost analyses of guideline implementation strategies. Eur J Health Econ 8, 111–121 (2007). https://doi.org/10.1007/s10198-007-0043-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10198-007-0043-8

Keywords

Search

Navigation