Linking quality of care and training costs: cost‐effectiveness in health professions education
Open Access
- 27 November 2015
- journal article
- research article
- Published by Wiley in Medical Education
- Vol. 49 (12), 1263-1271
- https://doi.org/10.1111/medu.12882
Abstract
To provide a model for conducting cost‐effectiveness analyses in medical education. The model was based on a randomised trial examining the effects of training midwives to perform cervical length measurement (CLM) as compared with obstetricians on patients' waiting times. (CLM), as compared with obstetricians. The model included four steps: (i) gathering data on training outcomes, (ii) assessing total costs and effects, (iii) calculating the incremental cost‐effectiveness ratio (ICER) and (iv) estimating cost‐effectiveness probability for different willingness to pay (WTP) values. To provide a model example, we conducted a randomised cost‐effectiveness trial. Midwives were randomised to CLM training (midwife‐performed CLMs) or no training (initial management by midwife, and CLM performed by obstetrician). Intervention‐group participants underwent simulation‐based and clinical training until they were proficient. During the following 6 months, waiting times from arrival to admission or discharge were recorded for women who presented with symptoms of pre‐term labour. Outcomes for women managed by intervention and control‐group participants were compared. These data were then used for the remaining steps of the cost‐effectiveness model. Intervention‐group participants needed a mean 268.2 (95% confidence interval [CI], 140.2‒392.2) minutes of simulator training and a mean 7.3 (95% CI, 4.4‒10.3) supervised scans to attain proficiency. Women who were scanned by intervention‐group participants had significantly reduced waiting time compared with those managed by the control group (n = 65; mean difference, 36.6 [95% CI 7.3‒65.8] minutes; p = 0.008), which corresponded to an ICER of 0.45 EUR minute−1. For WTP values less than EUR 0.26 minute−1, obstetrician‐performed CLM was the most cost‐effective strategy, whereas midwife‐performed CLM was cost‐effective for WTP values above EUR 0.73 minute−1. Cost‐effectiveness models can be used to link quality of care to training costs. The example used in the present study demonstrated that different training strategies could be recommended as the most cost‐effective depending on administrators' willingness to pay per unit of the outcome variable.Keywords
Funding Information
- TRYG Foundation
This publication has 33 references indexed in Scilit:
- Initial Laparoscopic Basic Skills Training Shortens the Learning Curve of Laparoscopic Suturing and Is Cost-EffectiveJournal of the American College of Surgeons, 2010
- Cost Savings From Reduced Catheter-Related Bloodstream Infection After Simulation-Based Education for Residents in a Medical Intensive Care UnitSimulation in healthcare : journal of the Society for Simulation in Healthcare, 2010
- A critical review of simulation-based medical education research: 2003–2009Medical Education, 2010
- Optimal Cost-Effectiveness Decisions: The Role of the Cost-Effectiveness Acceptability Curve (CEAC), the Cost-Effectiveness Acceptability Frontier (CEAF), and the Expected Value of Perfection Information (EVPI)Value in Health, 2008
- Using the net benefit regression framework to construct cost-effectiveness acceptability curves: an example using data from a trial of external loop recorders versus Holter monitoring for ambulatory monitoring of "community acquired" syncopeBMC Health Services Research, 2006
- Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birthPublished by Wiley ,2006
- The "Cost" of Operative Training for Surgical ResidentsArchives of Surgery, 2004
- Cost effectiveness of continuing professional development in health care: a critical review of the evidenceBMJ, 2002
- Effect of surgical training on outcome and hospital costs in coronary surgeryHeart, 2001
- Gaps in the continuity of care and progress on patient safetyBMJ, 2000