A framework for local-level economic evaluation to inform implementation decisions: health service interventions to prevent hospital-acquired hypoglycemia

Jodi Gray, Tilenka R. Thynne, Vaughn Eaton, Brianna Reade, Rebecca Larcombe, Linda Baldacchino, Jessica Gehlert, Paul Hakendorf, Jonathan Karnon, the Southern Adelaide Local Health Network’s (SALHN) Hypoglycaemia Clinical Working Group, Zoe Adey-Wakeling

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)
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Published evidence on health service interventions should inform decision-making in local health services, but primary effectiveness studies and cost-effectiveness analyses are unlikely to reflect contexts other than those in which the evaluations were undertaken. A ten-step framework was developed and applied to use published evidence as the basis for local-level economic evaluations that estimate the expected costs and effects of new service intervention options in specific local contexts. 


Working with a multidisciplinary group of local clinicians, the framework was applied to evaluate intervention options for preventing hospital-acquired hypoglycemia. The framework included: clinical audit and analyses of local health systems data to understand the local context and estimate baseline event rates; pragmatic literature review to identify evidence on relevant intervention options; expert elicitation to adjust published intervention effect estimates to reflect the local context; and modeling to synthesize and calibrate data derived from the disparate data sources. 


From forty-seven studies identified in the literature review, the working group selected three interventions for evaluation. The local-level economic evaluation generated estimates of intervention costs and a range of cost, capacity and patient outcome-related consequences, which informed working group recommendations to implement two of the interventions. 


The applied framework for modeled local-level economic evaluation was valued by local stakeholders, in particular the structured, formal approach to identifying and interpreting published evidence alongside local data. Key methodological issues included the handling of alternative reported outcomes and the elicitation of the expected intervention effects in the local context.

Original languageEnglish
Article numbere74
Number of pages11
JournalInternational Journal of Technology Assessment in Health Care
Issue number1
Publication statusPublished - 20 Dec 2023


  • cost-consequence analysis
  • decision analytic framework
  • elicitation
  • healthcare-acquired complications
  • hospital-acquired complications
  • local healthcare evaluation


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