Cost and effects of integrated care: a systematic literature review and meta-analysis
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ORIGINAL PAPER
Cost and effects of integrated care: a systematic literature review and meta‑analysis Stephen Rocks1 · Daniela Berntson1 · Alejandro Gil‑Salmerón2 · Mudathira Kadu3 · Nieves Ehrenberg4 · Viktoria Stein4 · Apostolos Tsiachristas1 Received: 11 September 2019 / Accepted: 30 June 2020 © The Author(s) 2020
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. Keywords Cost-effectiveness · Economic evaluation · Integrated care; meta-analysis
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10198-020-01217-5) contains supplementary material, which is available to authorized users. * Apostolos Tsiachristas [email protected] 1
Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
2
Polibienestar Research Institute, Universitat de València, Valencia, Spain
3
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
4
International Foundation for Integrated Care, Oxford, UK
Governments across high-income countries are challenged to contain the relentless increase in health expenditure, which is partly driv
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