scholarly journals Economic evaluation of guideline implementation in primary care: a systematic review

2019 ◽  
Vol 32 (1) ◽  
pp. 1-11
Author(s):  
Eva Kovacs ◽  
Xiaoting Wang ◽  
Ralf Strobl ◽  
Eva Grill
Keyword(s):  
Primary Care ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Guideline Implementation ◽  
Developed Countries ◽  
Lipid Lowering ◽  
Limited Information ◽  
Outreach Visit ◽  
Educational Meeting ◽  
Intervention Cost

Abstract Purpose To review the economic evaluation of the guideline implementation in primary care. Data sources Medline and Embase. Study selection Electronic search was conducted on April 1, 2019, focusing on studies published in the previous ten years in developed countries about guidelines of non-communicable diseases of adult (≥18 years) population, the interventions targeting the primary care provider. Data extraction was performed by two independent researchers using a Microsoft Access based form. Results of data synthesis Among the 1338 studies assessed by title or abstract, 212 qualified for full text reading. From the final 39 clinically eligible studies, 14 reported economic evaluation. Cost consequences analysis, presented in four studies, provided limited information. Cost-benefit analysis was reported in five studies. Patient mediated intervention, and outreach visit applied in two studies showed no saving. Audit resulted significant savings in lipid lowering medication. Audit plus financial intervention was estimated to reduce referrals into secondary care. Analysis of incremental cost-effectiveness ratios was applied in four studies. Educational meeting evaluated in a simulated practice was cost-effective. Educational meeting extended with motivational interview showed no improvement; likewise two studies of multifaceted intervention. Cost-utility analysis of educational meeting supported with other educational materials showed unfavourable outcome. Conclusion Only a minor proportion of studies reporting clinical effectiveness of guideline implementation interventions included any type of economic evaluation. Rigorous and standardized cost-effectiveness analysis would be required, supporting decision-making between simple and multifaceted interventions through comparability.

Economic Evaluation of CAM Use

2017 ◽  
pp. 232-271
Author(s):  
Li-Chia Chen ◽  
Mayuree Tangkiatkumjai
Keyword(s):  
Decision Making ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Conventional Medicine ◽  
Kidney Diseases ◽  
Developed Countries ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Healthcare Interventions

Economic evaluation (EE) of health care interventions has been used to inform and affect policy decision-making by considering both costs and outcomes of the interventions. National guidelines in many countries consider cost-effectiveness evidence for making recommendations of healthcare interventions. In such case, EE of complementary and alternative medicine (CAM) is crucial to guide reimbursement decision-making. However, there is currently a lack of cost-effectiveness evidence of using CAM for kidney diseases. There are three types of full EEs, including a cost-benefit, cost-effectiveness, and cost-utility analysis, of which, results of cost-utility analysis is preferred and widely used by healthcare authorities in several developed countries. General approaches for EE of conventional medicine are likely to be applied to assess economic outcomes of CAM for kidney diseases. This chapter depicts the overall principles of EEs, interpretations of economic results and summaries the currently available EE for CAM.

How cost-effective is nutrition care delivered in primary healthcare settings? A systematic review of trial-based economic evaluations

2021 ◽  
Author(s):  
Katelyn A Barnes ◽  
Zoe Szewczyk ◽  
Jaimon T Kelly ◽  
Katrina L Campbell ◽  
Lauren E Ball
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Data Extraction ◽  
Outcome Variable ◽  
Primary Care Settings ◽  
Nutrition Care ◽  
The Cost

Abstract Context Nutrition care is an effective lifestyle intervention for the treatment and prevention of many noncommunicable diseases. Primary care is a high-value setting in which to provide nutrition care. Objective The objective of this review was to evaluate the cost-effectiveness of nutrition care interventions provided in primary care settings. Data Sources Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Central Register of Controlled Trials, EconLit, and the National Health Service Economic Evaluation Database (NHS EED) were searched from inception to May 2021. Data Extraction Data extraction was guided by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) reporting guidelines. Randomized trials of nutrition interventions in primary care settings were included in the analysis if incremental cost-effectiveness ratios were reported. The main outcome variable incremental cost-effectiveness ratios (ICERs) and reported interpretations were used to categorize interventions by the cost-effectiveness plane quadrant. Results Of 6837 articles identified, 10 were included (representing 9 studies). Eight of the 9 included studies found nutrition care in primary care settings to be more costly and more effective than usual care . High study heterogeneity limited further conclusions. Conclusion Nutrition care in primary care settings is effective, though it requires investment; it should, therefore, be considered in primary care planning. Further studies are needed to evaluate the long-term cost-effectiveness of providing nutrition care in primary care settings. Systematic review registration PROSPERO registration no. CRD42020201146.

Economic evaluations of videoconference and telephone consultations in primary care: A systematic review

2021 ◽  
pp. 1357633X2110433
Author(s):  
Keshia R De Guzman ◽  
Centaine L Snoswell ◽  
Liam J Caffery ◽  
Anthony C Smith
Keyword(s):  
Primary Care ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Cost Minimization ◽  
Health Economic Evaluation ◽  
Reporting Quality ◽  
Cost Effective ◽  
Cost Utility ◽  
Economic Evaluations ◽  
Published Evidence

Introduction Telehealth services using videoconference and telephone modalities have been increasing exponentially in primary care since the coronavirus pandemic. The challenge now is ensuring that these services remain sustainable. This review investigates the cost-effectiveness of videoconference and telephone consultations in primary care settings, by summarizing the available published evidence. Methods A systematic search of PubMed, Embase, Scopus, and CINAHL databases was used to identify articles published from January 2000 to July 2020, using keyword synonyms for telehealth, primary care, and economic evaluation. Databases were searched, and title, abstract, and full-text reviews were conducted. Article reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. Results Twenty articles were selected for inclusion, with 12 describing telephone triage services, seven describing telehealth substitution services, and one describing another telehealth service in primary care. These services were delivered by nurses, doctors, and allied health clinicians. Of the 20 included studies, 11 used cost analyses, five used cost-minimization analyses, and four used one or more methods, including either a cost–consequence analysis, a cost–utility analysis, or a cost-effectiveness analysis. Conclusions Telephone and videoconference consultations in primary care were cost-effective to the health system when deemed clinically appropriate, clinician when time was used efficiently, and when overall demand on health services was reduced. The societal benefits of telehealth consultations should be considered an important part of telehealth planning and should influence funding reform decisions for telehealth services in primary care.

Cost-Effectiveness of a Chronic Care Model for Frail Older Adults in Primary Care: Economic Evaluation Alongside a Stepped-Wedge Cluster-Randomized Trial

2015 ◽  
Vol 63 (12) ◽  
pp. 2494-2504 ◽  
Author(s):  
Karen M. van Leeuwen ◽  
Judith E. Bosmans ◽  
Aaltje P. D. Jansen ◽  
Emiel O. Hoogendijk ◽  
Maaike E. Muntinga ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Chronic Care Model ◽  
Chronic Care ◽  
Cluster Randomized Trial ◽  
Stepped Wedge ◽  
Care Model ◽  
Cluster Randomized

scholarly journals Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e030110 ◽  
Author(s):  
Joanna Thorn ◽  
Mei-See Man ◽  
Katherine Chaplin ◽  
Peter Bower ◽  
Sara Brookes ◽  
...  
Keyword(s):  
Primary Care ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Usual Care ◽  
Randomised Trial ◽  
Mean Difference ◽  
Secondary Outcome ◽  
Cluster Randomised Trial ◽  
Cluster Randomised ◽  
The Cost

ObjectivePatients with multiple chronic health conditions are often managed in a disjointed fashion in primary care, with annual review clinic appointments offered separately for each condition. This study aimed to determine the cost-effectiveness of the 3D intervention, which was developed to improve the system of care.DesignEconomic evaluation conducted alongside a pragmatic cluster-randomised trial.SettingGeneral practices in three centres in England and Scotland.Participants797 adults with three or more chronic conditions were randomised to the 3D intervention, while 749 participants were randomised to receive usual care.InterventionThe 3D approach: comprehensive 6-monthly general practitioner consultations, supported by medication reviews and nurse appointments.Primary and secondary outcome measuresThe primary economic evaluation assessed the cost per quality-adjusted life year (QALY) gained from the perspective of the National Health Service (NHS) and personal social services (PSS). Costs were related to changes in a range of secondary outcomes (QALYs accrued by both participants and carers, and deaths) in a cost–consequences analysis from the perspectives of the NHS/PSS, patients/carers and productivity losses.ResultsVery small increases were found in both QALYs (adjusted mean difference 0.007 (−0.009 to 0.023)) and costs (adjusted mean difference £126 (£−739 to £991)) in the intervention arm compared with usual care after 15 months. The incremental cost-effectiveness ratio was £18 499, with a 50.8% chance of being cost-effective at a willingness-to-pay threshold of £20 000 per QALY (55.8% at £30 000 per QALY).ConclusionsThe small differences in costs and outcomes were consistent with chance, and the uncertainty was substantial; therefore, the evidence for the cost-effectiveness of the 3D approach from the NHS/PSS perspective should be considered equivocal.Trial registration numberISCRTN06180958

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