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Results for 'economic evaluation'

Results 1 - 10 of 24

Signposting and navigation services for older people: economic evidence

BAUER Annette, et al

Health, social care and other local government services can help ‘signpost’ or facilitate links to community and voluntary organisations that can help address social isolation and loneliness. This summary presents evidence on the effectiveness and cost-effectiveness of signposting and navigation to tackle loneliness experienced by older people. It draws on evidence from a systematic review funded by The Campaign to End Loneliness. The evidence suggests that signposting and navigation services have the potential to achieve positive return on investments. However, evidence is restricted to a few small-scale studies and modelling. Further research is needed to test those findings.

Help-at-home for older people: economic evidence

BAUER Annette, TINELLI Michela, GUY Danielle

This case summary provides economic evidence on Help-at-home schemes for older people, drawing on an economic evaluation of a scheme run by Age UK in England. Help-at-home schemes are usually run by voluntary and community organisations, and provide older people with a range of community support services to support older people living in their own homes. These services can include emotional, social, practical and financial support. Evidence from the evaluation suggests that Help-at-home schemes save local government and the NHS around £1500 per person per year, owing to people remaining longer in their homes, fewer GP appointments, and fewer hospital admissions. Volunteers providing support may also benefit, making them more likely to find jobs after gaining skills through volunteering. The summary notes that many of the benefits of help-at-home schemes are likely to depend on local infrastructures and how such schemes are run, making it hard to generalise their value.

British Red Cross 'Support at Home' hospital discharge scheme. A small-scale social care intervention: economic evidence

KNAPP Martin, et al

This case summary presents economic evidence on British Red Cross 'Support at Home' hospital discharge scheme. Through the scheme volunteers offer short-term (4–12 week) practical and emotional support for older people recently discharged from the hospital. A British Red Cross evaluation of the schemes effectiveness identified benefits such as enabling safe discharge, supporting carers and enabling patient advocacy. The intervention costs an average £169 per person, including volunteer time. The programme led to savings from older people needing less help with daily activities and improvements in wellbeing. These savings amounted to £884 per person on average (costs are at 2011 price levels). The summary notes that the quality of evidence on the evaluation was not high due to a lack of control group.

Economic evaluation of a falls prevention exercise program among people With Parkinson's disease

FARAG Inez, et al

Objective: The aim of this study was to determine the cost‐effectiveness of a 6‐month minimally supervised exercise program for people with PD. Methods: An economic analysis was conducted alongside a randomized, controlled trial in which 231 people age 40 years and over with PD were randomized into a usual care control group or an exercise group. Cost‐effectiveness was estimated using incremental cost per fall prevented (using falls calendars) as the primary analysis and cost per extra person avoiding mobility deterioration (defined as an improvement or no change in the 12‐point Short Physical Performance Battery Score between baseline and 6 month). A cost‐utility analysis using the Short Form‐6D was also performed. Uncertainty was represented using cost‐effectiveness scatter plots and acceptability curves. Planned subgroup analyses for the low‐disease‐severity group were also undertaken. Results: All results are reported in Australian dollars ($A). The average cost of the intervention was $A1,010 per participant. Incremental cost‐effectiveness of the program relative to usual care was $A574 per fall prevented, $A9,570 per extra person avoiding mobility deterioration, and $A338,800 per quality‐adjusted life year gained. The intervention had an 80% probability of being cost‐effective, relative to the control, at a threshold of $A2,000 per fall prevented. Subgroup analyses for the low‐disease‐severity group indicate the program to be dominant, that is, less costly and more effective than usual care for all health outcomes. Conclusion: The exercise intervention appeared cost‐effective with regard to fall prevention in the whole sample and cost saving in the low disease severity group, when compared with usual care.

Effects of participating in community assets on quality of life and costs of care: longitudinal cohort study of older people in England

MUNFORD Luke Aaron, et al

Objectives: Improving outcomes for older people with long-term conditions and multimorbidity is a priority. Current policy commits to substantial expansion of social prescribing to community assets, such as charity, voluntary or community groups. This study uses longitudinal data to add to the limited evidence on whether this is associated with better quality of life or lower costs of care. Design: Prospective 18-month cohort survey of self-reported participation in community assets and quality of life linked to administrative care records. Effects of starting and stopping participation estimated using double-robust estimation. Setting: Participation in community asset facilities. Costs of primary and secondary care. Participants 4377 older people with long-term conditions. Intervention Participation in community assets. Primary and secondary outcome measures Quality-adjusted life years (QALYs), healthcare costs and social value estimated using net benefits. Results: Starting to participate in community assets was associated with a 0.017 (95% CI 0.002 to 0.032) gain in QALYs after 6 months, 0.030 (95% CI 0.005 to 0.054) after 12 months and 0.056 (95% CI 0.017 to 0.094) after 18 months. Cumulative effects on care costs were negative in each time period: £−96 (95% CI £−512 to £321) at 6 months; £−283 (95% CI £−926 to £359) at 12 months; and £−453 (95% CI £−1366 to £461) at 18 months. The net benefit of starting to participate was £1956 (95% CI £209 to £3703) per participant at 18 months. Stopping participation was associated with larger negative impacts of −0.102 (95% CI −0.173 to −0.031) QALYs and £1335.33 (95% CI £112.85 to £2557.81) higher costs after 18 months. Conclusions: Participation in community assets by older people with long-term conditions is associated with improved quality of life and reduced costs of care. Sustaining that participation is important because there are considerable health changes associated with stopping. The results support the inclusion of community assets as part of an integrated care model for older patients.

Cost-effectiveness of telecare for people with social care needs: the Whole Systems Demonstrator cluster randomised trial

HENDERSON Catherine, et al

Purpose of the study: to examine the costs and cost-effectiveness of ‘second-generation’ telecare, in addition to standard support and care that could include ‘first-generation’ forms of telecare, compared with standard support and care that could include ‘first-generation’ forms of telecare. Design and methods: a pragmatic cluster-randomised controlled trial with nested economic evaluation. A total of 2,600 people with social care needs participated in a trial of community-based telecare in three English local authority areas. In the Whole Systems Demonstrator Telecare Questionnaire Study, 550 participants were randomised to intervention and 639 to control. Participants who were offered the telecare intervention received a package of equipment and monitoring services for 12 months, additional to their standard health and social care services. The control group received usual health and social care. Primary outcome measure: incremental cost per quality-adjusted life year (QALY) gained. The analyses took a health and social care perspective. Results: cost per additional QALY was £297,000. Cost-effectiveness acceptability curves indicated that the probability of cost-effectiveness at a willingness-to-pay of £30,000 per QALY gained was only 16%. Sensitivity analyses combining variations in equipment price and support cost parameters yielded a cost-effectiveness ratio of £161,000 per QALY. Implications: while QALY gain in the intervention group was similar to that for controls, social and health services costs were higher. Second-generation telecare did not appear to be a cost-effective addition to usual care, assuming a commonly accepted willingness to pay for QALYs.

Agents for change: an evaluation of the Somerset Village Agents programme


An evaluation of the Somerset Village Agents programme, which aims to reduce isolation and help connect excluded and vulnerable people with services that support them to improve their independence, health and wellbeing. It uses locally based staff who act as first point of contact for people needing information and support. The evaluation, undertaken jointly by South West Forum and Clarity CiC with support from University of Gloucestershire, included analysis of client data, interviews with clients and discussions with locally based staff. Analysis was carried out between October 2016 and February 2017. The results of the evaluation found that the Somerset Village Agents programme is highly regarded by clients, statutory agencies and voluntary and public organisations who have a connection with the programme. It is also helping the most isolated, lonely and vulnerable people in the community, especially older people and those with disabilities and/or long-term health conditions. Areas for potential improvement identified by the evaluation included expanding reach of the programme to reach more younger people and more work to build community capacity. A cost benefit analysis of the programme estimates that for the 21-month period reviewed the Village Agents programme cost £646,000 to deliver and generated £2.5 million in direct savings to the state and a further £2.74 million in wider social value. The report makes recommendations for the future development of the programme.

Are acceptance and mindfulness‐based interventions ‘value for money’? Evidence from a systematic literature review

DUARTE Rui, et al

Objectives: Acceptance and mindfulness‐based interventions (A/MBIs) are recommended for people with mental health conditions. Although there is a growing evidence base supporting the effectiveness of different A/MBIs for mental health conditions, the economic case for these interventions has not been fully explored. The aim of this systematic review was to identify and appraise all available economic evidence of A/MBIs for the management of mental health conditions. Methods: Eight electronic bibliographic databases (MEDLINE, MEDLINE In‐Process & Other Non‐Indexed Citations, EMBASE, Web of Science, NHS Economic Evaluation Database (EED), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA) database, and EconLit) were searched for relevant economic evaluations published from each database's inception date until November 2017. Study selection, quality assessment, and data extraction were carried out according to published guidelines. Results: Ten relevant economic evaluations presented in 11 papers were identified. Seven of the included studies were full economic evaluations (i.e., costs and effects assessed), and three studies were partial economic evaluations (i.e., only costs were considered in the analysis). The A/MBIs that had been subjected to economic evaluation were acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), mindfulness‐based cognitive therapy (MBCT), and mindfulness‐based stress reduction (MBSR). In terms of clinical presentations, the evaluation of cost‐effectiveness of A/MBIs has been more focused on depression and emotional unstable personality disorder with three and four economic evaluations, respectively. Three out of seven full economic evaluations observed that A/MBIs were cost‐effective for the management of mental health conditions. Nevertheless, the heterogeneity of included populations, interventions, and economic evaluation study types limits the extent to which firm conclusions can currently be made. Conclusion: This first substantive review of economic evaluations of A/MBIs indicates that more research is needed before firm conclusions can be reached on the cost‐effectiveness of A/MBIs for mental health conditions.

The (cost‐)effectiveness of preventive, integrated care for community‐dwelling frail older people: a systematic review

LOOMAN Wilhelmina Mijntje, HUIJSMAN Robbert, FABBRICOTTI Isabelle Natalina

Integrated care is increasingly promoted as an effective and cost‐effective way to organise care for community‐dwelling frail older people with complex problems but the question remains whether high expectations are justified. Our study aims to systematically review the empirical evidence for the effectiveness and cost‐effectiveness of preventive, integrated care for community‐dwelling frail older people and close attention is paid to the elements and levels of integration of the interventions. We searched nine databases for eligible studies until May 2016 with a comparison group and reporting at least one outcome regarding effectiveness or cost‐effectiveness. We identified 2,998 unique records and, after exclusions, selected 46 studies on 29 interventions. We assessed the quality of the included studies with the Effective Practice and Organization of Care risk‐of‐bias tool. The interventions were described following Rainbow Model of Integrated Care framework by Valentijn. Our systematic review reveals that the majority of the reported outcomes in the studies on preventive, integrated care show no effects. In terms of health outcomes, effectiveness is demonstrated most often for seldom‐reported outcomes such as well‐being. Outcomes regarding informal caregivers and professionals are rarely considered and negligible. Most promising are the care process outcomes that did improve for preventive, integrated care interventions as compared to usual care. Healthcare utilisation was the most reported outcome but we found mixed results. Evidence for cost‐effectiveness is limited. High expectations should be tempered given this limited and fragmented evidence for the effectiveness and cost‐effectiveness of preventive, integrated care for frail older people. Future research should focus on unravelling the heterogeneity of frailty and on exploring what outcomes among frail older people may realistically be expected.

Economic evaluations of falls prevention programs for older adults: a systematic review

OLIJ Branko F., et al

Objectives: To provide a comprehensive overview of economic evaluations of falls prevention programs and to evaluate the methodology and quality of these studies. Design: Systematic review of economic evaluations on falls prevention programs. Setting: Studies (N=31) of community‐dwelling older adults (n=25), of older adults living in residential care facilities (n=3), and of both populations (n=3) published before May 2017. Participants: Adults aged 60 and older. Measurements: Information on study characteristics and health economics was collected. Study quality was appraised using the 20‐item Consensus on Health Economic Criteria. Results: Economic evaluations of falls prevention through exercise (n = 9), home assessment (n = 6), medication adjustment (n = 4), multifactorial programs (n = 11), and various other programs (n = 13) were identified. Approximately two‐thirds of all reported incremental cost‐effectiveness ratios (ICERs) with quality‐adjusted life‐years (QALYs) as outcome were below the willingness‐to‐pay threshold of $50,000 per QALY. All studies on home assessment and medication adjustment programs reported favorable ICERs, whereas the results of studies on exercise and multifactorial programs were inconsistent. The overall methodological quality of the studies was good, although there was variation between studies. Conclusion: The majority of the reported ICERs indicated that falls prevention programs were cost‐effective, but methodological differences between studies hampered direct comparison of the cost‐effectiveness of program types. The results imply that investing in falls prevention programs for adults aged 60 and older is cost‐effective. Home assessment programs (ICERs < $40,000/QALY) were the most cost‐effective type of program for community‐dwelling older adults, and medication adjustment programs (ICERs < $13,000/QALY) were the most cost‐effective type of program for older adults living in a residential care facility.

Results 1 - 10 of 24


Moving Memory

Moving Memory Practice example about how the Moving Memory Dance Theatre Company is challenging perceived notions of age and ageing.

Chatty Cafe Scheme

Chatty Cafe Scheme Practice example about how the Chatty Cafe Scheme is helping to tackle loneliness by bringing people of all ages together

Oomph! Wellness

Oomph! Wellness Practice example about how Oomph! Wellness is supporting staff to get older adults active and combat growing levels of social isolation


KOMP Practice example about how KOMP, designed by No Isolation is helping older people stay connected with their families

LAUGH research project

LAUGH research project Practice example about a research project to develop highly personalised, playful objects for people with advanced dementia
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