Abstract

Objectives: A review of the empirical literature was undertaken to examine economic evaluation methods for assessing long-term care interventions. Together with other experts in the field, the authors reflect on methods for the economic evaluation of long-term care interventions. The research seeks to identify whether the evaluation of care services poses particular methodological challenges, and to explore how these may be addressed.

Data and Methods: Search strategies were designed, incorporating key terms and were not restricted by date or type of intervention. Thirteen health, care and economic bibliographic databases were searched to identify relevant literature, and experts were consulted. Data on study characteristics, the decision making problem and context, costs and outcomes measured and valued, including informal care, multi-sector implications and equity were extracted.

Results: 29 studies were reviewed, following de-duplication and applying inclusion and exclusion criteria to 6,082 abstracts. Evidence from the review suggests that there was a general lack of clarity in methodological considerations and reporting of the decision problem, context and perspective of the analysis. Methodological challenges and considerable heterogeneity exists in the measurement and valuation of outcomes and informal carer time, the assessment of multi-sector costs and consequences and equity issues. 79% of studies included more than one outcome measure. A variety of outcome measures were used, even when evaluating the same intervention, complicating crossstudy comparison. Informal care was measured and valued in 38% of studies. All these took a human capital approach to valuing time however within this approach a number of different wage estimates were used. 90% of studies included costs falling on the health care sector. Other, broader costs were included in 84% of studies. Equity was referred to in one study only.

Policy Implications: Generation of good quality evidence on cost-effectiveness is essential if those commissioning services are to make well informed decisions about the optimal allocation of health and care resources. The methodological issues identified were not handled well and require further development. The review highlights key methodological challenges for the economic evaluation of long term care interventions and, building on the knowledge of experts in the field, draws out lessons to be learnt in undertaking these analyses. Additional methodological development and greater clarity on methods for assessing the cost-effectiveness of care interventions will facilitate the analysts’ ability to undertake useful evaluations to inform decision making.

Slides