Strategies to implement evidence-based practices consume scarce resources and incur costs. Although critical for decision makers, such resource use and cost information are not typically reported. This is at least partly due to a lack of clearly defined and standardized costing methods for use in implementation science. This study presents a pragmatic approach to systemically estimating resource use and costs of implementation strategies using a well-established business accounting system. The method is demonstrated by estimating the implementation costs of a cognitive behavioral therapy program for students with externalizing disorders in six Philadelphia schools.

Time-driven activity-based costing (TDABC) is combined with the existing guidelines forimplementation strategy specification and reporting. Implementation protocol, measures, project notes and key personnel interviews are used to map the implementation process by specifying the strategies with their actors, specific action steps, temporality, and frequency and intensity of action steps. Project resources are identified, andthe unit price of effort is calculated. Costs of action steps, strategies and implementation project is reported from a payer perspective.

Estimated total cost was $63,842; $10,640 per school. The largest cost was for the communication efforts ($30,691), which involved in-person meetings, phone calls, and email exchanges. Next largest costs were for the stakeholder engagement, consultation/coaching, and supervision, which comprised 19%, 15%, 12% of total costs, respectively. Assessment/evaluation and training constituted the smallest costs, at 4% and 3% respectively.

This method allows for inclusion of implementation costs in the efforts of strategy specification, tracking and reporting. It serves as a pragmatic tool to operationalize the conduct of the implementation activities, track the resources consumed and estimate associated costs. It could facilitate the routine incorporation of cost analysis and economic evaluations into implementation research. It provides granular cost information which could be used to identify and address the inefficiencies in the implementation process.