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

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.

The Cost Consequences of the Gold Coast Integrated Care Programme

“…The economic findings were unexpected based on the findings of previous research [ 37 ], but evaluations of integrated care (IC) programmes come with challenges that have been acknowledged in other contexts. Most integrated care programmes are highly variable in terms of programme components and delivery, making cost comparisons elusive [ 1 37 ]. Kadu et al’s [ 38 ] systematic review of the quality of economic evaluations in IC found that few programmes reported cost reductions.…”

“…Instead, the issue was insufficient implementation time, due to a longer than anticipated patient recruitment period, delaying implementation of the full suite of programme components. Other researchers have also found that the cost effectiveness of programmes is typically linked to having sufficient follow-up time to show the impact of IC models [ 4 37 38 46 ]. Bardsley et al [ 47 ] evaluated eight UK programmes and found few cost savings, suggesting a need for longer follow-up to show economic responsiveness.…”

The effect of payment method and multimorbidity on health and healthcare utilisation

“…Following evidence-based guidelines for patients with multiple chronic conditions, which schemes such as pay-for-performance encourage adherence to, may result in adverse drug and care interactions (Boyd et al , 2005; Marengoni and Onder, 2015). The integrated care models which have been most successful to date are longer-term and disease management models for single conditions (Rocks et al , 2020), which might, in fact, have negative effects for multimorbid patients. Another relevant area of the literature to consider is multitasking (Holmstrom and Milgrom, 1991) when some conditions are not included in the schemes.…”

Barriers to Integration of Primary Care into Emergency Care: Experiences in Germany

“… * We were to reassess and focus on cost comparisons in the broader roll out of the project in the second phase, but the project was terminated early. A recent meta-analysis serves as a useful guide in the cost analysis of integrated care projects [ 19 ]. …”

“…First person experiences of study PCP * We were to reassess and focus on cost comparisons in the broader roll out of the project in the second phase, but the project was terminated early. A recent meta-analysis serves as a useful guide in the cost analysis of integrated care projects [19]. patients to be those of low urgency/acuity, self-referred, presenting for a new episode of care (i.e.…”