Determining the Cost-Effectiveness of Home Care: A Scoping Review

Abstract

Context: The demand for long-term care services provided at home (home care) has increased over time. However, we do not know whether home care is cost-effective with respect to other care options. This restricts the ability of policymakers to allocate the limited resources for long-term care efficiently. Objectives: The purpose of this scoping review is to understand what is already known about the comparative cost-effectiveness of home care versus other care options, different modes of home care and different intensities of home care. Methods: We searched six electronic databases in January and February 2023. A total of 1,191 items were identified and reviewed. Fourteen papers were thematically analysed, and the findings were presented under four themes: definition of home care and comparators; measurement of outcomes and costs; treatment of informal care; and methods. Findings: The existing evaluations of home care lack a standardised framework for measuring outcomes, costs and the impact of informal care and suffer from methodological limitations. Evidence on the comparison between traditional home care options and other models of home-based care, such as directly employed personal assistants or extra care housing schemes, is currently missing. Limitations: The definition of home care can vary across countries and studies, which may affect our ability to capture relevant literature. Implications: Future work in the evaluation of home care will need to use new outcome measures, incorporate caregivers’ outcomes, and employ newer statistical methods. Relevant authorities also need to prioritise making routinely collected data linkable and accessible.