u/gabriellar135
Separating affordability from cost-effectiveness when scaling an intervention.
Within the payer’s budget horizon, which training and replacement staffing costs remain payable when scheduled nurses don’t attend?
That distinction changes how I’d structure the budget impact analysis. I’d model a temporary bottleneck by shifting training cohorts and annual spending across the payer’s horizon, while a persistent capacity limit changes total uptake and may lower cumulative spending without making the intended scale feasible.
Both should be measured, but they should not be placed in the same budget category. Over the payer’s horizon, reimbursed travel, paid training time, and replacement staffing affect affordability directly. Unpaid attendance and unreimbursed travel fall outside the payer’s cash budget, yet excluding them would hide costs shifted to nurses. Report those separately and state the analytic perspective used for each comparison.
