Cost and effects of integrated care: a systematic literature review and meta-analysis

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Abstract

Background

Health and care services are becoming increasingly strained and healthcare authorities worldwide are investing in integrated care in the hope of delivering higher-quality services while containing costs. The cost-effectiveness of integrated care, however, remains unclear. This systematic review and meta-analysis aims to appraise current economic evaluations of integrated care and assesses the impact on outcomes and costs.

Methods

CINAHL, DARE, EMBASE, Medline/PubMed, NHS EED, OECD Library, Scopus, Web of Science, and WHOLIS databases from inception to 31 December 2019 were searched to identify studies assessing the cost-effectiveness of integrated care. Study quality was assessed using an adapted CHEERS checklist and used as weight in a random-effects meta-analysis to estimate mean cost and mean outcomes of integrated care.

Results

Selected studies achieved a relatively low average quality score of 65.0% (± 18.7%). Overall meta-analyses from 34 studies showed a significant decrease in costs (0.94; CI 0.90–0.99) and a statistically significant improvement in outcomes (1.06; CI 1.05–1.08) associated with integrated care compared to the control. There is substantial heterogeneity in both costs and outcomes across subgroups. Results were significant in studies lasting over 12 months (12 studies), with both a decrease in cost (0.87; CI 0.80–0.94) and improvement in outcomes (1.15; 95% CI 1.11–1.18) for integrated care interventions; whereas, these associations were not significant in studies with follow-up less than a year.

Conclusion

Our findings suggest that integrated care is likely to reduce cost and improve outcome. However, existing evidence varies largely and is of moderate quality. Future economic evaluation should target methodological issues to aid policy decisions with more robust evidence on the cost-effectiveness of integrated care.

Electronic supplementary material

The online version of this article (10.1007/s10198-020-01217-5) contains supplementary material, which is available to authorized users.

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Most cited references 76

Record: found
Abstract: not found
Article: not found

Measuring inconsistency in meta-analyses.

Julian P. T. Higgins, Simon Thompson, Jonathan Deeks … (2003)

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Record: found
Abstract: found
Article: not found

Meta-analysis in clinical trials.

R DerSimonian, N Laird (1986)

This paper examines eight published reviews each reporting results from several related trials. Each review pools the results from the relevant trials in order to evaluate the efficacy of a certain treatment for a specified medical condition. These reviews lack consistent assessment of homogeneity of treatment effect before pooling. We discuss a random effects approach to combining evidence from a series of experiments comparing two treatments. This approach incorporates the heterogeneity of effects in the analysis of the overall treatment efficacy. The model can be extended to include relevant covariates which would reduce the heterogeneity and allow for more specific therapeutic recommendations. We suggest a simple noniterative procedure for characterizing the distribution of treatment effects in a series of studies.

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Is Open Access

Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement

Don Husereau, Michael F Drummond, Stavros Petrou … (2013)

Economic evaluations of health interventions pose a particular challenge for reporting. There is also a need to consolidate and update existing guidelines and promote their use in a user friendly manner. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement is an attempt to consolidate and update previous health economic evaluation guidelines efforts into one current, useful reporting guidance. The primary audiences for the CHEERS statement are researchers reporting economic evaluations and the editors and peer reviewers assessing them for publication. The need for new reporting guidance was identified by a survey of medical editors. A list of possible items based on a systematic review was created. A two round, modified Delphi panel consisting of representatives from academia, clinical practice, industry, government, and the editorial community was conducted. Out of 44 candidate items, 24 items and accompanying recommendations were developed. The recommendations are contained in a user friendly, 24 item checklist. A copy of the statement, accompanying checklist, and this report can be found on the ISPOR Health Economic Evaluations Publication Guidelines Task Force website (http://www.ispor.org/TaskForces/EconomicPubGuidelines.asp). We hope CHEERS will lead to better reporting, and ultimately, better health decisions. To facilitate dissemination and uptake, the CHEERS statement is being co-published across 10 health economics and medical journals. We encourage other journals and groups, to endorse CHEERS. The author team plans to review the checklist for an update in five years.

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Author and article information

Contributors

Apostolos Tsiachristas:

ORCID: http://orcid.org/0000-0002-4662-8915

apostolos.tsiachristas@ndph.ox.ac.uk

Journal

Journal ID (nlm-ta): Eur J Health Econ

Journal ID (iso-abbrev): Eur J Health Econ

Title: The European Journal of Health Economics

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 1618-7598

ISSN (Electronic): 1618-7601

Publication date (Electronic): 6 July 2020

Publication date PMC-release: 6 July 2020

Publication date (Print): 2020

Volume: 21

Issue: 8

Pages: 1211-1221

Affiliations

[1 ]GRID grid.4991.5, ISNI 0000 0004 1936 8948, Health Economics Research Centre, Nuffield Department of Population Health, , University of Oxford, ; Oxford, UK

[2 ]GRID grid.5338.d, ISNI 0000 0001 2173 938X, Polibienestar Research Institute, Universitat de València, ; Valencia, Spain

[3 ]GRID grid.17063.33, ISNI 0000 0001 2157 2938, Institute of Health Policy, Management and Evaluation, , University of Toronto, ; Toronto, ON Canada

[4 ]International Foundation for Integrated Care, Oxford, UK

Author information

Stephen Rocks http://orcid.org/0000-0001-7633-7708

Apostolos Tsiachristas http://orcid.org/0000-0002-4662-8915

Article

Publisher ID: 1217

DOI: 10.1007/s10198-020-01217-5

PMC ID: 7561551

PubMed ID: 32632820

SO-VID: 4eff58c2-1177-4d41-835b-533cd0d90f09

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 11 September 2019

Date accepted : 30 June 2020

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100013373, NIHR Oxford Biomedical Research Centre;

Funded by: Applied Research Collaboration Oxford and Thames Valley

Custom metadata

ScienceOpen disciplines: Economics of health & social care

Keywords: cost-effectiveness,economic evaluation,integrated care; meta-analysis

Data availability:

ScienceOpen disciplines: Economics of health & social care

Keywords: cost-effectiveness, economic evaluation, integrated care; meta-analysis

Cost and effects of integrated care: a systematic literature review and meta-analysis

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Most cited references 76

Measuring inconsistency in meta-analyses.

Meta-analysis in clinical trials.

Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement

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