Cost effectiveness of continuing professional development in health care: a critical review of the evidence.

Continuing professional development (CPD) for healthcare professionals is an important strategic instrument for improving health. The Department of Health identifies CPD as a way of maintaining standards of care; improving the health of the nation; and recruiting, motivating, and retaining high quality staff. To this end, direct NHS spending on continuing professional development in 1999-2000 was about £1bn ($1.6bn). 3 If we regard CPD as any method to improve health professionals’ skills the total resources devoted to it are probably much greater, particularly with the recent increased participation in response to the need for recertification and revalidation. To ensure the maximum gain from participation in CPD, these resources must be used efficiently. To assess the efficiency of participating in CPD, economic criteria are needed. Resources for health care are scarce, and money spent on CPD could otherwise be used for direct patient care. These opportunity costs are explicitly considered in the economic methods of cost benefit analysis and cost effectiveness analysis. The literature contains various reviews of cost effectiveness analysis in both health care 6 and education. Such articles explain why cost effectiveness analysis (or another method of economic evaluation) is essential and how such evaluation should be undertaken, and they clearly define the set of economic terms (such as cost benefit analysis, cost effectiveness analysis, rate of return, and opportunity cost) that need to be incorporated into this type of research. Casebeer et al highlighted the need for economic evaluation of CPD activities, but they emphasised the use of cost benefit analysis, which requires monetary values to be assigned to measures of effectiveness. Cost benefit analysis is generally used to ascertain whether an intervention should be undertaken. Cost effectiveness analysis is used to decide which interventions (out of a number of alternatives) should be undertaken. However, cost effectiveness analysis in education research is rare. 9 10 This is partly because of limited training for researchers, antipathy toward (economic) analysis that might constrain policy, and the dearth of significant results in studies of educational effectiveness. The quality of such research is also often poor: Clune found that only 1% of 541 “cost-effectiveness” studies of elementary and secondary education between 1991 and 1996 could be considered reliable, with strong design and analysis. In contrast, economic evaluation of healthcare technologies is increasing, and the methods for making such analysis are rapidly evolving. (Even here, however, critical reviews identify a substantial number of weak cost benefit and cost effectiveness analyses.) There is a sizeable literature on the effectiveness of CPD interventions (over 100 randomised controlled trials are thoroughly reviewed by Davis et al ), but the evidence on the cost effectiveness of CPD has not been systematically investigated. In this article we therefore investigate the quantity and quality of the evidence on the cost effectiveness of CPD for healthcare professionals.