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

Author

Listed:
  • Stephen Rocks

    (University of Oxford)

  • Daniela Berntson

    (University of Oxford)

  • Alejandro Gil-Salmerón

    (Polibienestar Research Institute, Universitat de València)

  • Mudathira Kadu

    (University of Toronto)

  • Nieves Ehrenberg

    (International Foundation for Integrated Care)

  • Viktoria Stein

    (International Foundation for Integrated Care)

  • Apostolos Tsiachristas

    (University of Oxford)

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.

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  • Stephen Rocks & Daniela Berntson & Alejandro Gil-Salmerón & Mudathira Kadu & Nieves Ehrenberg & Viktoria Stein & Apostolos Tsiachristas, 2020. "Cost and effects of integrated care: a systematic literature review and meta-analysis," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(8), pages 1211-1221, November.
    • Handle: RePEc:spr:eujhec:v:21:y:2020:i:8:d:10.1007_s10198-020-01217-5
    DOI: 10.1007/s10198-020-01217-5
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    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 26th October 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-10-26 12:00:03

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    Cited by:

    1. Vanessa Ress & Eva‐Maria Wild, 2024. "The impact of integrated care on health care utilization and costs in a socially deprived urban area in Germany: A difference‐in‐differences approach within an event‐study framework," Health Economics, John Wiley & Sons, Ltd., vol. 33(2), pages 229-247, February.
    2. Karen Beny & Benjamin du Sartz de Vigneulles & Florence Carrouel & Denis Bourgeois & Valérie Gay & Claude Negrier & Claude Dussart, 2022. "Haemophilia in France: Modelisation of the Clinical Pathway for Patients," IJERPH, MDPI, vol. 19(2), pages 1-14, January.
    3. Guillaume Sekli, 2022. "A cooperative game approach to integrated healthcare," Working Papers 2022-06, CRESE.
    4. Zonneveld, Nick & Glimmerveen, Ludo & Kenis, Patrick & Toro Polanco, Nuria & Johansen, Anne S. & Minkman, Mirella M.n., 2022. "Values underpinning integrated, people-centred health services : Similarities and differences among actor groups across Europe," Other publications TiSEM ad0d23d2-8217-451e-bb5f-3, Tilburg University, School of Economics and Management.

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