The expected value of implementation: the use of iterative expert elicitation and scenario analyses within decision‑analytic models of health services

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Health economists can inform the management of integrated services, rather than merely the adoption of discrete and disjointed products e.g., pharmaceuticals and devices. But this is not so simple. During ex-ante value-based planning of interventions, consideration is required of implementation fidelity within complex and dynamic systems. Potential misalignments require adaptations to resourcing, but also our expectations of effects and, therefore, cost-effectiveness i.e., value and success.


While embedded within Local Health Networks in South Australia, we conducted interviews and retroductive analyses to conceptualise decision problems and the logic behind interventions. We then conducted expert elicitation of quantitative estimates of expected future effects, which were used to model the expected cost-effectiveness of theorised service interventions. Finally, scenario analyses were used to explore the implementation costs necessary to minimise the likelihood of poor fidelity and sustainability.


Expected effects include non-inferior outcomes, financial savings, and repurposed capacity. There have been moderate levels of disagreement among stakeholders regarding the scale and uncertainty of expected effects ex-ante. Theorised adaptations included the need for unscheduled meetings, backup/redundant equipment, and “exceptional circumstance” responsibilities. Steep learning effects are also expected regarding the “risk appetite” of referrers. Modelled cost-effectiveness is sensitive to scenarios of poor adaptation and patient selection.


Modelled evaluations feed into business cases and living analytical models. While value is context-dependent, methods are generalisable. We highlight the potential of a Value of Implementation equation to price-in resources or “operational slack” for expected adaptations based on acceptable likelihoods of realised and sustained costs and effects.
Original languageEnglish
Article numberO29
Number of pages1
JournalImplementation Science
Issue number2
Publication statusPublished - 7 Sept 2023
Event2nd Implementation Science Health Conference Australia - Sydney, Australia
Duration: 23 Mar 202324 Mar 2023


  • Health care delivery
  • Integrated health care systems
  • Value of Implementation


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