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Economic evaluation of intrahospital clinical practices in injury care: protocol for a 10-year systematic review
  1. Blanchard Conombo1,2,
  2. Jason Robert Guertin1,
  3. Pier-Alexandre Tardif2,
  4. Imen Farhat2,
  5. Thomas Moore2,
  6. Samy Bouderba2,
  7. Kahina Soltana2,
  8. Patrick Archambault3,
  9. Simon Berthelot2,3,
  10. François Lauzier2,4,
  11. Alexis F Turgeon2,4,
  12. Henry Thomas Stelfox5,
  13. Michaël Chasse6,
  14. Jeffrey Hoch7,
  15. Lynne Moore1,2
  1. 1Department of Social and Preventive Medicine, Laval University, Quebec City, Quebec, Canada
  2. 2Population Health and Optimal Health Practices Research Unit, Trauma – Emergency – Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l’Enfant-Jésus), Laval University, Quebec City, Quebec, Canada
  3. 3Department of Family Medicine and Emergency Medicine, Laval University, Quebec City, Quebec, Canada
  4. 4Department of Anesthesia and Critical Care Medicine, Laval University, Quebec City, Quebec, Canada
  5. 5Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
  6. 6Department of Medicine, University of Montreal, Montreal, Quebec, Canada
  7. 7Department of Public Health Sciences, University of California, Sacramento, California, USA
  1. Correspondence to Blanchard Conombo; blanchard.conombo.1{at}ulaval.ca

Abstract

Introduction Underuse of high-value clinical practices and overuse of low-value practices are major sources of inefficiencies in modern healthcare systems. Injuries are second only to cardiovascular disease in terms of acute care costs but data on the economic impact of clinical practices for injury admissions are lacking. This study aims to summarise evidence on the economic value of intrahospital clinical practices for injury care.

Methods and analysis We will perform a systematic review to identify research articles in economic evaluation of intrahospital clinical practices in acute injury care. We will search MEDLINE and databases such as Embase, Web of Science, NHS Economic Evaluation Database, Cochrane CENTRAL, BIOSIS and CINAHL for randomised or non-randomised controlled trials and observational studies using a combination of keywords and controlled vocabulary. We will consider the following outcomes relative to economic evaluations: incremental cost-effectiveness ratio, incremental cost-utility ratio, incremental net health benefit, incremental net monetary benefit (iNMB) and incremental cost-benefit ratio. Pairs of independent reviewers will evaluate studies that meet eligibility criteria and extract data from included articles using an electronic data extraction form. All outcomes will be converted into iNMB. We will report iNMB for practices classified by type of practice (hospitalisation, consultation, diagnostic, therapeutic-surgical, therapeutic-drugs, therapeutic-other). Results obtained with a ceiling ratio of $50 000 per quality-adjusted life year gained for identified clinical practices will be summarised by charting forest plots. In line with Cochrane recommendations for systematic reviews of economic evaluations, meta-analyses will not be conducted.

Ethics and dissemination Ethics approval is not required as original data will not be collected. This study will summarise existing evidence on the economic value of clinical practices in injury care. Results will be used to advance knowledge on value-based care for injury admissions and will be disseminated through a peer-reviewed article, international scientific meetings and clinical and healthcare quality associations.

  • injury
  • value-based care
  • low-value clinical practices
  • health economics
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

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  • Contributors BC led the development of the protocol and drafted the manuscript. JRG contributed to the development of research objectives and inclusion criteria, elaborated keywords, validated the data extraction form, critically revised the manuscript and approved the final version. P-AT contributed to the elaboration of keywords, developed and tested the search strategy, critically revised and approved the final version of the manuscript. IF contributed to the elaboration of keywords, developed and tested the search strategy, critically revised and approved the final version of the manuscript. TM contributed to the elaboration of keywords, developed and tested the search strategy, critically revised and approved the final version of the manuscript. SaB contributed to the elaboration of keywords, developed and tested the search strategy, critically revised and approved the final version of the manuscript. KS contributed to the elaboration of keywords, developed and tested the search strategy, critically revised and approved the final version of the manuscript. PA contributed to working definitions, developed keywords, revised the manuscript and approved the final version. SiB contributed to the development of research objectives and inclusion criteria, elaborated keywords, critically revised the manuscript and approved the final version. FL contributed to developing keywords, validated the search strategy and the data extraction form, revised the manuscript and approved the final version. AFT elaborated inclusion criteria and clinically significant outcomes, validated the search strategy, elaborated keywords, revised the manuscript and approved the final version. HTS contributed to the development of research objectives, inclusion criteria, the search strategy and the extraction form, developed keywords, revised the manuscript and approved the final version. MC validated the search strategy and the data extraction form, revised the manuscript and approved the final version. JH contributed to working definitions, developed keywords, revised the manuscript and approved the final version. LM led the development of the protocol and drafted the manuscript. She acts as guarantor for the review.

  • Funding This research was supported by the Canadian Institutes of Health Research (foundation grant number 353374 and Embedded Clinician Researcher (PA)). LM, JRG, FL and MC are recipients of a research salary award from the Fonds de Recherche du Québec – Santé (FRQS). AFT is the Canada Research Chair in Critical Care Neurology and Trauma. The funders had no role in developing this protocol.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.