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Economic evaluations of audit and feedback interventions: a systematic review
  1. Lynne Moore1,
  2. Jason Robert Guertin1,
  3. Pier-Alexandre Tardif1,
  4. Noah Michael Ivers2,
  5. Jeffrey Hoch3,
  6. Blanchard Conombo1,
  7. Jesmin Antony4,
  8. Henry Thomas Stelfox5,
  9. Simon Berthelot1,
  10. Patrick Archambault1,
  11. Alexis Turgeon1,
  12. Rohit Gandhi6,
  13. JM Grimshaw7
  1. 1Population Health and Optimal Health Practices Research Unit, Trauma – Emergency – Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Quebec, Canada
  2. 2Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Public Health Sciences, University of California San Francisco, San Francisco, California, USA
  4. 4Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
  5. 5Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
  6. 6Department of Pediatric Neurology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
  7. 7Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  1. Correspondence to Dr Lynne Moore, Population Health and Optimal Health Practices Research Unit, Trauma – Emergency – Critical Care Medicine, CHU de Québec-Université Laval, Quebec, QC G1J 1Z4, Canada; lynne.moore{at}fmed.ulaval.ca

Abstract

Background The effectiveness of audit and feedback (A&F) interventions to improve compliance to healthcare guidelines is supported by randomised controlled trials (RCTs) and meta-analyses of RCTs. However, there is currently a knowledge gap on their cost-effectiveness.

Objective We aimed to assess whether A&F interventions targeting improvements in compliance to recommended care are economically favourable.

Methods We conducted a systematic review including experimental, observational and simulation-based economic evaluation studies of A&F interventions targeting healthcare providers. Comparators were a ‘do nothing’ strategy, or any other intervention not involving A&F or involving a subset of A&F intervention components. We searched MEDLINE, CINAHL, CENTRAL, Econlit, EMBASE, Health Technology Assessment Database, MEDLINE, NHS Economic Evaluation Database, ABI/INFORM, Web of Science, ProQuest and websites of healthcare quality associations to December 2021. Outcomes were incremental cost-effectiveness ratios, incremental cost-utility ratios, incremental net benefit and incremental cost-benefit ratios. Pairs of reviewers independently selected eligible studies and extracted relevant data. Reporting quality was evaluated using CHEERS (Consolidated Health Economic Evaluation Reporting Standards). Results were synthesised using permutation matrices for all studies and predefined subgroups.

Results Of 13 221 unique citations, 35 studies met our inclusion criteria. The A&F intervention was dominant (ie, at least as effective with lower cost) in 7 studies, potentially cost-effective in 26 and was dominated (ie, the same or less effectiveness and higher costs) in 2 studies. A&F interventions were more likely to be economically favourable in studies based on health outcomes rather than compliance to recommended practice, considering medical costs in addition to intervention costs, published since 2010, and with high reporting quality.

Discussion Results suggest that A&F interventions may have a high potential to be cost-effective. However, as is common in systematic reviews of economic evaluations, publication bias could have led to an overestimation of their economic value.

  • Audit and feedback
  • Healthcare quality improvement
  • Cost-effectiveness

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Twitter @noahivers, @simon_berthelot, @GrimshawJeremy

  • Contributors LM led the conception and design of the work as well as the acquisition, analysis and interpretation of the data, drafted the manuscript, gave final approval for publication and is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. P-AT, JBG, JG, NMI, JH, BC and JA made substantial contributions to the conception and design, the acquisition, analysis and interpretation of data, drafting and revising the work for important intellectual content, gave final approval for publication and are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. NMI, JH, BC and JA made substantial contributions to the conception and design, the acquisition, analysis and interpretation of data, revising the work for important intellectual content, gave final approval for publication and are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. HTS, AT and RG made substantial contributions to the interpretation of data, revising the work for important intellectual content, gave final approval for publication and are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. LM accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding This study was funded by the Canadian Institutes of Health Research (168833, 353374).

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.