Economic evaluation of deimplementation interventions: a systematic review.

Abstract

Background: Low-value practices, defined as tests or treatments that are used in practice despite not being supported by evidence, account for 20%-30% of healthcare expenditure; moreover, some identified low-value practices represent 16%-26% of primary care clinical services. Given the growing financial constraints healthcare systems face, evaluating the cost-effectiveness of interventions designed to reduce these practices is becoming urgent.

Objective: We aimed to synthesise data on the economic value of deimplementation interventions.

Methods: We evaluated the cost-effectiveness of interventions targeting the deimplementation of low-value practices among healthcare professionals and organisations (clinicians, hospitals and medical centres). Our comparator was either no intervention or a deimplementation intervention limited to a subset of the intervention components. Outcomes were incremental cost-effectiveness ratios, incremental cost-utility ratios and benefit-to-cost ratios. Studies where the intervention was dominant or dominated by the comparator were also considered. We developed search strategies for Cochrane, EMBASE, MEDLINE, CINAHL and Web of Science to February 2025. Pairs of independent reviewers sequentially screened titles, abstracts and full texts for eligibility and extracted data using a prepiloted extraction sheet. Methodological quality was assessed by two reviewers using the 19-item Consensus on Health Economic Criteria (CHEC), and results were synthesised visually using permutation matrices globally and for predefined subgroups.

Results: Of the 35 575 unique records identified, 19 met our eligibility criteria. Deimplementation interventions were found to be dominant (ie, effective with lower cost) in 10 evaluations (53%), potentially favourable (more effective with higher cost) in 8 (42%) and unfavourable in 1 (5%). Deimplementation interventions were more likely to be economically favourable in studies accounting for both medical and intervention costs, those targeting healthcare professionals and those with high methodological quality.

Conclusion: Our findings suggest that deimplementation interventions targeting low-value practices are highly likely to be cost-effective. However, the results should be interpreted with caution due to the low methodological quality of the studies and the lack of consideration of the societal perspective.