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Evaluation of a predevelopment service delivery intervention: an application to improve clinical handovers
  1. Guiqing Lily Yao1,
  2. Nicola Novielli1,
  3. Semira Manaseki-Holland1,
  4. Yen-Fu Chen1,
  5. Marcel van der Klink2,
  6. Paul Barach3,4,5,
  7. Peter J Chilton1,
  8. Richard J Lilford1,
  9. on behalf of the European HANDOVER Research Collaborative*
  1. 1Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
  2. 2Centre for Learning Sciences and Technologies, Open Universiteit Nederland, Heerlen, The Netherlands
  3. 3Utrecht Medical Center, Utrecht, The Netherlands
  4. 4University of Stavanger, Stavanger, Norway
  5. 5University College Cork, Cork, Ireland
  6. *The European HANDOVER Research Collaborative consists of: Venneri F, Molisso A (Azienda Sanitaria Firenze, Italy), Albolino S, Toccafondi G (Clinical Risk Management and Patient Safety Center, Tuscany Region, Italy), Barach P, Gademan P, Göbel B, Johnson J, Kalkman C, Pijnenborg L (Patient Safety Center, University Medical Center Utrecht, Utrecht, The Netherlands), Wollersheim H, Hesselink G, Schoonhoven L, Vernooij-Dassen M, Zegers M (Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands), Boshuizen E, Drachsler H, Kicken W, van der Klink M, Stoyanov S (Centre for Learning Sciences and Technologies, Open University, Heerlen, The Netherlands), Kutryba B, Dudzik-Urbaniak E, Kalinowski M, Kutaj-Wasikowska H (National Center for Quality Assessment in Health Care, Krakow, Poland), Suñol R, Groene O, Orrego C (Avedis Donabedian Institute, Universidad Autónoma de Barcelona, Barcelona, Spain), Öhlén G, Airosa F, Bergenbrant S, Flink M, Hansagi H, Olsson M (Karolinska University Hospital, Stockholm, Sweden), Lilford R, Chen Y-F, Novielli N, Manaseki-Holland S (University of Birmingham, Birmingham, United Kingdom).
  1. Correspondence to Dr Richard J Lilford, Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Edgbaston, West Midlands, Birmingham B15 2TT, UK; r.j.lilford{at}


Background We developed a method to estimate the expected cost-effectiveness of a service intervention at the design stage and ‘road-tested’ the method on an intervention to improve patient handover of care between hospital and community.

Method The development of a nine-step evaluation framework:

1. Identification of multiple endpoints and arranging them into manageable groups;

2. Estimation of baseline overall and preventable risk;

3. Bayesian elicitation of expected effectiveness of the planned intervention;

4. Assigning utilities to groups of endpoints;

5. Costing the intervention;

6. Estimating health service costs associated with preventable adverse events;

7. Calculating health benefits;

8. Cost-effectiveness calculation;

9. Sensitivity and headroom analysis.

Results     Literature review suggested that adverse events follow 19% of patient discharges, and that one-third are preventable by improved handover (ie, 6.3% of all discharges). The intervention to improve handover would reduce the incidence of adverse events by 21% (ie, from 6.3% to 4.7%) according to the elicitation exercise. Potentially preventable adverse events were classified by severity and duration. Utilities were assigned to each category of adverse event. The costs associated with each category of event were obtained from the literature. The unit cost of the intervention was €16.6, which would yield a Quality Adjusted Life Year (QALY) gain per discharge of 0.010. The resulting cost saving was €14.3 per discharge. The intervention is cost-effective at approximately €214 per QALY under the base case, and remains cost-effective while the effectiveness is greater than 1.6%.

Conclusions We offer a usable framework to assist in ex ante health economic evaluations of health service interventions.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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