Study selection

A rapid review was conducted to identify published studies estimating the incremental costs or cost-effectiveness of long-term care interventions in four policy intervention areas:

  • Reducing dependency

  • Maximising coordination

  • New models of care

  • Unpaid carers.


Criteria for inclusion were that studies should:

  • Relate to a long-term care intervention;

  • Detail unit costs for individual resource categories (or allow for unit costs to be inferred);

  • Detail levels of resource use by treatment arm; and

  • Provide central (deterministic) cost estimates that could be replicated on the basis of reported unit costs and resource use.

Details of studies selected for inclusion based on these criteria are below.

• Reducing dependency

Evaluation of the Individual Budgets Pilot Programme. Glendinning C (2008)


Evaluation of a piloting of Individual Budgets: a mechanism for care users to exercise control over how resources allocated to them are spent to best meet their needs. Health and social care resource use data among individual budget users and a comparison group were collected six months after baseline Outcomes were measured using the ASCOT social care outcome measure and the GHQ-12. Cost-effectiveness findings varied substantially by client-group: follow-up costs per incremental change in ASCOT were estimated at £–222 overall, £43,000 among adults with learnings disabilities and £-61 among older people.

www.york.ac.uk/inst/spru/pubs/pdf/IBSEN.pdf




Is Short-Term Palliative Care Cost-Effective in Multiple Sclerosis? A Randomized Phase II Trial. Higginson I, McCrone P, Hart S, Burman R, Silber E, Edmonds P (2009)


Evaluation of the cost-effectiveness of a new palliative care service for people with multiple sclerosis in England. Patients were randomly allocated to a multiprofessional care team immediately (intervention group) or were offered the intervention after three months (control group). Resource use and outcome data were collected at baseline and at 6, 12, 18 and 26 week follow-ups. Mean service costs (including informal care) during the initial 12 weeks were estimated to be £1,789 lower in the intervention group than the control group.

www.jpsmjournal.com/article/S0885-3924(09)00741-6/pdf




Building a business case for investing in adaptive technologies in England. Snell T, Fernandez J, Forder J (2012)


Based on evidence from existing literature, the study estimated the costs and benefits associated with receipt of aids and adaptations among dependent older people in England. Using a decision-tree structure, the model estimated the incidence and costs of episodes avoided through the receipt of the intervention. Central findings suggested the intervention to be cost-effective assuming a willingness-to-pay threshold of £20,000 to £30,000 per QALY.

www.pssru.ac.uk/pub/dp2831.pdf





• Maximising coordination

Intermediate care including reablement. Bauer A, Fernandez J (2017)


An evaluative study contributing to the development of NICE guidelines on the cost-effectiveness of intermediate care interventions and approaches in England. The original analysis investigated lifetime costs: bespoke estimates have been produced for international cost comparisons based on a five-year follow-up period. Base country estimates suggested reablement to be cost-saving on the basis of health and social care costs over the follow-up period.

https://www.nice.org.uk/guidance/ng74/evidence/appendix-c3-economic-report-pdf-4600707954




Effectiveness and cost-effectiveness of a proactive, goal-oriented, integrated care model in general practice for older people. A cluster randomised controlled trial: Integrated Systematic Care for older People—the ISCOPE study. Blom J, Elzen W, Houwelingen A, Heijmans M, Stijnen T, Van der Hout W, Gussekloo J (2016)


Assesses the effectiveness and cost-effectiveness of a structural monitoring system to detect deterioration in individuals in the Netherlands aged 75 and over, with the execution of care plans for those identified as having complex problems. While found to be preferable among general practitioners, no positive effects were found in terms of costs or patient quality of life.

www.ncbi.nlm.nih.gov/pmc/articles/PMC4711660




Buying Time II: an economic evaluation of a joint NHS/Social Services residential rehabilitation unit for older people on discharge from hospital. Ellis A, Trappes-Lomax T, Fox M, Taylor R, Power M, Stead J, Bainbridge I (2005)


Investigates the cost-effectiveness of an NHS/Social Services short-term rehabilitation unit for older people in England, aimed at helping individuals to regain independence. NHS and social care costs over 12 months were compared between those that attended there unit and those that were sent straight home. Aggregated mean costs were £8,542 in the intervention group and £8,511 in the control group, suggesting the intervention to be no more cost-effective than usual care. However, the study found significant differences in the burden of payment: costs fell mainly on social care departments for the intervention group, and mainly on the NHS for usual care.

www.ncbi.nlm.nih.gov/pubmed/16460359





• New models of care

Evaluation of the Individual Budgets Pilot Programme. Glendinning C (2008)


Evaluation of a piloting of Individual Budgets: a mechanism for care users to exercise control over how resources allocated to them are spent to best meet their needs. Health and social care resource use data among individual budget users and a comparison group were collected six months after baseline Outcomes were measured using the ASCOT social care outcome measure and the GHQ-12. Cost-effectiveness findings varied substantially by client-group: follow-up costs per incremental change in ASCOT were estimated at £–222 overall, £43,000 among adults with learnings disabilities and £-61 among older people.

www.york.ac.uk/inst/spru/pubs/pdf/IBSEN.pdf




Is Short-Term Palliative Care Cost-Effective in Multiple Sclerosis? A Randomized Phase II Trial. Higginson I, McCrone P, Hart S, Burman R, Silber E, Edmonds P (2009)


Evaluation of the cost-effectiveness of a new palliative care service for people with multiple sclerosis in England. Patients were randomly allocated to a multiprofessional care team immediately (intervention group) or were offered the intervention after three months (control group). Resource use and outcome data were collected at baseline and at 6, 12, 18 and 26 week follow-ups. Mean service costs (including informal care) during the initial 12 weeks were estimated to be £1,789 lower in the intervention group than the control group.

www.jpsmjournal.com/article/S0885-3924(09)00741-6/pdf




Building a business case for investing in adaptive technologies in England. Snell T, Fernandez J, Forder J (2012)


Based on evidence from existing literature, the study estimated the costs and benefits associated with receipt of aids and adaptations among dependent older people in England. Using a decision-tree structure, the model estimated the incidence and costs of episodes avoided through the receipt of the intervention. Central findings suggested the intervention to be cost-effective assuming a willingness-to-pay threshold of £20,000 to £30,000 per QALY.

www.pssru.ac.uk/pub/dp2831.pdf





• Unpaid carers

Does befriending by trained lay workers improve psychological well-being and quality of life for carers of people with dementia, and at what cost? A randomised controlled trial. Charlesworth G, Shepstone L, Wilson E, Thalanany M, Mugford M, Poland F (2008)


Based on data from a randomised controlled trial, the study aimed to establish whether carer access to a befriending facilitator in addition to usual care was effective and cost-effective relative to usual care alone. The intervention was found to be neither effective or cost-effective in the support of carers, although the study suggested potential cost-effectiveness when adopting a combined perspective of carers and care users.

www.ncbi.nlm.nih.gov/pubmed/18284895




Cost effectiveness of a manual based coping strategy programme in promoting the mental health of family carers of people with dementia (the START (STrAtegies for RelaTives) study): a pragmatic randomised controlled trial. Knapp M, King D, Romeo R, Schehl B, Barber J, Griffin M, Rapaport P, Livingston D, Mummery C, Walker Z, Hoe J, Sampson E, Cooper C, Livingston G (2013)


The study aimed to assess whether the START (STrAtegies for RelatTives) intervention added to treatment as usual is cost effective compared with usual treatment for family carers of people with dementia. When added to treatment as usual, the intervention was found to be cost effective by reference to combined outcome measures (affective symptoms for family carers, and carer based QALYs).

www.bmj.com/content/347/bmj.f6342





Project title: European network on long-term care quality and cost-effectiveness and dependency prevention. 

With financial support from the European Union under grant agreement No VS/2015/0276

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