Cost-effectiveness of integrated care in frail elderly using the ICECAP-O and EQ-5D: does choice of instrument matter?

Introduction: Living with dementia is challenging for persons with dementia (PWDs) and their families. Although multi-component intervention, underscored by the ethos of person-centred care, has been shown to maintain quality of life (QOL) in PWDs and caregivers, a lack of service integration can hinder effectiveness. Methods: CARITAS, an integrated care initiative provided through a hospital-community care partnership, endeavours to provide person-centred dementia care through ambulatory clinic consults, case management, patient and caregiver engagement, and support. We evaluated CARITAS’ clinical outcomes and cost-effectiveness with a naturalistic cross-sectional within-subject design. We assessed patients’ function, QOL, and behavioural problems post-intervention. We estimated CARITAS’ cost-effectiveness from a patient’s perspective, benchmarking it against other dementia treatments and Singapore’s Gross Domestic Product (GDP) per capita. Results: CARITAS care significantly improved health utility (p < 0.001), reduced caregiver burden (p < 0.001), and improved PWDs’ behavioural problems (p < 0.001) related to “memory” (p < 0.001), “disruption” (p = 0.017), and “depression” (p < 0.001). CARITAS’ benefits (dRMBPC = 0.357, dEQ5D index = 0.328, dZBI = 0.361) were comparable to those of other pharmacological and non-pharmacological interventions for dementia. CARITAS costs SG$133,056.69 per quality-adjusted life years gain, yielding an incremental cost-effectiveness ratio of 1.31 and 1.49 against the cost of donepezil in patients with mild Alzheimer’s disease and Singapore’s GDP per capita in 2019, respectively, falling within the cost-effectiveness threshold of 1.0–3.0. Discussion: CARITAS integrated dementia care is a cost-effective intervention that showed promising outcomes for PWDs and their caregivers.

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The effects of an integrated care intervention for the frail elderly on informal caregivers: a quasi-experimental study

BMC Geriatrics ◽

10.1186/1471-2318-14-58 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 13

Author(s):

Benjamin Janse ◽

Robbert Huijsman ◽

Ruben Dennis Maurice de Kuyper ◽

Isabelle Natalina Fabbricotti

Keyword(s):

Experimental Study ◽

Integrated Care ◽

Frail Elderly ◽

Informal Caregivers ◽

Care Intervention ◽

Quasi Experimental

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A cost effectiveness study of integrated care in health services delivery: a diabetes program in Australia

BMC Health Services Research ◽

10.1186/1472-6963-8-205 ◽

2008 ◽

Vol 8 (1) ◽

Cited By ~ 22

Author(s):

Ian S McRae ◽

James RG Butler ◽

Beverly M Sibthorpe ◽

Warwick Ruscoe ◽

Jill Snow ◽

...

Keyword(s):

Cost Effectiveness ◽

Health Services ◽

Integrated Care ◽

Effectiveness Study ◽

Health Services Delivery ◽

Services Delivery ◽

Cost Effectiveness Study

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Cost-effectiveness of mobile health-based integrated care for atrial fibrillation: Model development and data analysis (Preprint)

10.2196/preprints.29408 ◽

2021 ◽

Author(s):

Xueyan Luo ◽

Wei Xu ◽

Quan Yuan ◽

Han Lai ◽

Chunji Huang

Keyword(s):

Atrial Fibrillation ◽

Sensitivity Analysis ◽

Cost Effectiveness ◽

Integrated Care ◽

Mobile Health ◽

Cost Effective ◽

Sensitivity Analyses ◽

Base Case ◽

Life Years ◽

Mhealth Technology

BACKGROUND Mobile health (mhealth) technology is increasingly used in disease management. Using mhealth tools to integrate and streamline care was found to improve atrial fibrillation (AF) patients’ clinical outcomes. OBJECTIVE This study aimed to investigate the potential clinical and health economic outcomes of mhealth-based integrated care for AF from the perspective of a public healthcare provider in China. METHODS A Markov model was designed to compare outcomes of mhealth-based care and usual care in a hypothetical cohort of AF patients in China. The time horizon was 30 years with monthly cycles. Model outcomes measured were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were conducted to examine the robustness of base-case results. RESULTS In the base-case analysis, mhealth-based care gained higher QALYs of 0.0818 with an incurred cost of USD1,778. Using USD33,438 per QALY (three times gross domestic product) as the willingness-to-pay threshold, mhealth-based care was cost-effective, with an ICER of USD21,739 per QALY. The one-way sensitivity analysis found compliance to mhealth-based care had the greatest impact on the ICER. In probabilistic sensitivity analysis, mhealth-based care was accepted as cost-effective in 80.91% of 10,000 iterations. CONCLUSIONS This study suggested that the use of mhealth technology in streamlining and integrating care for AF patients was cost-effective in China.

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Effectiveness and cost-effectiveness of integrated care models for elderly, complex patients: A narrative review. Don’t we need a value-based approach?

International Journal of Care Coordination ◽

10.1177/2053434518817019 ◽

2018 ◽

Vol 21 (4) ◽

pp. 120-139 ◽

Cited By ~ 4

Author(s):

Marta Marino ◽

Antonio G de Belvis ◽

Maria Tanzariello ◽

Emanuele Dotti ◽

Sabina Bucci ◽

...

Keyword(s):

Cost Effectiveness ◽

Health Outcomes ◽

Integrated Care ◽

Service Providers ◽

Systems Of Care ◽

Social Needs ◽

Narrative Review ◽

A Value ◽

Care Models ◽

Integrated Care Models

Introduction The management of patients with complex health and social needs is one of the main challenges for healthcare systems. Integrated care seems to respond to this issue, with collaborative working and integration efforts of the care system components professionals and service providers aimed at improving efficiency, appropriateness and person centeredness of care. We conducted a narrative review to analyse the available evidences published on effectiveness and cost-effectiveness of integrated care models targeted on the management of such elderly patients. Methods MEDLINE, Scopus and EBSCO were searched. We reported this narrative review according to the PRISMA Checklist. For studies to be included, they had to: (i) refer to integrated care models through implemented experimental or demonstration projects; (ii) focus on frail elderly ≥65 years old, with complex health and social needs, not disease-specific; (iii) evaluate effectiveness and/or cost and/or cost-effectiveness; (iv) report quantitative data (e.g. health outcomes, utilization outcomes, cost and cost-effectiveness). Results Thirty articles were included, identifying 13 integrated care models. Common features were identified in case management, geriatric assessment and multidisciplinary team. Favourable impacts on healthcare facilities utilization rates, though with mixed results on costs, were found. The development of community-based and cost-effective integrated systems of care for the elderly is possible, thanks to the cooperation across care professionals and providers, to achieving a relevant impact on healthcare and efficient resource management. The elements of success or failure are not always unique and identifiable, but the potential clearly exists for these models to be successful and generalized on a large scale. Discussion We found out a favourable impact of integrated care models/methods on health outcomes, care utilization and costs. The selected interventions are likely to be implemented at community level, focused on the patient management in terms of continuity of care. Thus, we propose a value-based framework for the evaluation of these services.

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