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Evidence-based Implementation

In Bandolier 18 we carried a simple economic matrix as an aide to decision-making. A more detailed version of this has been developed with Geof McHugh of AEA Technology. It can act as an aid to deciding implementation priorities. Bandolier has used this frequently in talks over the last few months, and publishes it here by request.

The matrix balances the health care benefits of, say, a new treatment against the comparative resource use (a much more useful phrase in the health service than cost).

The matrix indicates, for example, that if a new treatment carries significant healthcare benefits (low NNTs when compared with existing treatment) and consumes fewer health service resources, then it should be implemented immediately. Concrete examples might be Helicobacter eradication in peptic ulcer disease, or influenza vaccination in the elderly.

A comparison of two treatments, one of which had more adverse effects at higher cost might well be placed at the other extreme - do not pursue.

Like all such aides-memoir, it will help in some cases but not in others. However, as information about clinical and cost-effectiveness is increasingly packaged together in user-friendly lumps (as, for example from the Cochrane Collaboration and the Centre for Reviews and Dissemination), then the chart might just be a useful fixture on the wall above your desk to help in evidence-based priority setting and implementation.

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