Abstract
Introduction:The aim of this review is to systematically assess the methodological quality of economic evaluations in integrated care and to identify challenges with conducting such studies.Theory and methods:Searches of grey-literature and scientific papers were performed, from January 2000 to December 2018. A checklist was developed to assess the quality of economic evaluations. Authors’ statements of challenges encountered during their evaluations were qualitatively coded.Results:Forty-four articles were eligible for inclusion. The review found that study design, measurement of cost and outcomes, statistical analysis and presentation of data were the areas with most quality variation. Authors identified challenges mostly related to time horizon of the evaluation, inadequate or lack of comparator group, contamination bias, and a post-hoc evaluation culture.Discussion:Our review found significant differences in quality, with some studies showing poor methodological rigor; challenging conclusions on the cost-effectiveness of integrated care.Conclusion:It is essential for evaluators to use best-practice standards when planning and conducting economic evaluations, in order to build a reliable evidence base for decision-making in integrated care.
Highlights
The aim of this review is to systematically assess the methodological quality of economic evaluations in integrated care and to identify challenges with conducting such studies
Similar to Nolte and Pitchforth’s review of systematic reviews on the economic impacts of integrated care, we found wide variability across study designs, measurements of costs and outcomes, as well as analytical approaches and presentation of results [5]
This can make it significantly more difficult to perform rigorous economic evaluations; especially when health economists are not involved in the study design
Summary
The aim of this review is to systematically assess the methodological quality of economic evaluations in integrated care and to identify challenges with conducting such studies. Discussion: Our review found significant differences in quality, with some studies showing poor methodological rigor; challenging conclusions on the cost-effectiveness of integrated care. The recent paradigm shift in care delivery, from acute and segmented care, to preventive and coordinated care, is in alignment with the WHO Framework on Integrated People-centred Health Services. This framework calls for more integrated approaches to how services are funded, managed and delivered [4]. Different types of integrated care models have been designed
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