TY - JOUR T1 - The Evolving Economics of Implementation JF - BMJ Quality & Safety JO - BMJ Qual Saf DO - 10.1136/bmjqs-2021-014411 SP - bmjqs-2021-014411 AU - Kathleen Knocke AU - Todd W Wagner Y1 - 2021/12/05 UR - http://qualitysafety.bmj.com/content/early/2021/12/05/bmjqs-2021-014411.abstract N2 - Decision makers in healthcare systems strive to implement evidence-based, high-quality care. A lack of economic data is often cited as a barrier to implementation, especially when decision makers are asked to allocate finite resources and face competing demands.1–3 Studies that evaluate the cost of implementation strategies remain rare, and often these studies only estimate the implementation costs without connecting those investments to patient outcomes. In this issue of BMJ Quality & Safety, in a cost-effectiveness evaluation of a quality improvement project to improve thrombolysis door-to-needle times in a large Norwegian stroke centre, Ajmi and colleagues4 report that their implementation strategies cost $44 802 (US$) in fixed costs and $2141 per month in recurring costs. Further, they report an incremental cost per life-year saved that ranged from $4961–$10 543 (US$) over a 5-year period, with the range reflecting different assumptions made in a sensitivity analysis.The authors should be commended for estimating the incremental cost per life-year saved, incorporating costs of implementation of the intervention. This information alone may help in allocating scarce resources. However, we suspect that many decision makers will remain uncertain about whether they should try to replicate these efforts in their own systems.One challenge with economic evaluations is providing enough context by which other decision makers can easily determine the generalisability of the findings to their own systems. Such knowledge is necessary if there is a desire to spread and replicate this work in other systems. In the study on which Ajmi and colleagues’ analysis is based, the door-to-needle time was cut in half (from a median of 27 min to 13 min). On one hand, … ER -