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Results for 'economic evaluation'

Results 1 - 10 of 17

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.

Quantifying the benefits of peer support for people with dementia: a social return on investment (SROI) study

WILLIS Elizabeth, SEMPLE Amy C., de WAAL Hugo

Objective: Peer support for people with dementia and carers is routinely advocated in national strategies and policy as a post-diagnostic intervention. However there is limited evidence to demonstrate the value these groups offer. This study looked at three dementia peer support groups in South London to evaluate what outcomes they produce and how much social value they create in relation to the cost of investment. Methods: A Social Return on Investment (SROI) analysis was undertaken, which involves collecting data on the inputs, outputs and outcomes of an intervention, which are put into a formula, the end result being a SROI ratio showing how much social value is created per £1 of investment. Results: Findings showed the three groups created social value ranging from £1.17 to £5.18 for every pound (£) of investment, dependent on the design and structure of the group. Key outcomes for people with dementia were mental stimulation and a reduction in loneliness and isolation. Carers reported a reduction in stress and burden of care. Volunteers cited an increased knowledge of dementia. Conclusions: This study has shown that peer groups for people with dementia produce a social value greater than the cost of investment which provides encouraging evidence for those looking to commission, invest, set up or evaluate peer support groups for people with dementia and carers. Beyond the SROI ratio, this study has shown these groups create beneficial outcomes not only for the group members but also more widely for their carers and the group volunteers.

Making the case for investing in actions to prevent and/or tackle loneliness: a systematic review. A briefing paper

MCDAID David, BAUER Annette, PARK A-La

Summarises findings from a systematic review on the available economic evidence on the cost effectiveness of loneliness interventions for older people. The review found mixed evidence for the cost effectiveness of befriending interventions and the benefits of participation in social activities, ranging from cost saving to cost ineffective interventions. Recent evidence identified suggests that signposting and navigation services have the potential to be cost effective, with a saving of up to £3 of health costs for every £1 invested. The paper also makes suggestions for strengthening the evidence based on the cost effectiveness of interventions to address loneliness.

The social and economic impact of the Rotherham Social Prescribing Pilot: main evaluation report


Provides a detailed assessment of the social and economic impact of the Rotherham Social Prescribing Pilot from the perspective of key stakeholders. Social prescribing provides a way of linking patients in primary care and their carers with nonmedical sources of support within the community. Over the course of the pilot: 24 voluntary and community organisations (VCOs) received grants with a total value of just over £600,000 to deliver a menu of 31 separate social prescribing services; 1,607 patients were referred to the service, of whom 1,118 were referred on to funded VCS services; the five most common types of funded services referred to were information and advice, community activity, physical activities, befriending and enabling. The evaluation looked at the impact on the demand for hospital care and the economic and social benefits. The findings demonstrate that economic and social outcomes have been created for three main stakeholder groups: patients with LTCs and their carers, who have experienced improved mental health and greater engagement with the community; the local public sector, in particular health bodies, which have benefited from the reduced use of hospital resources; and the local voluntary and community sector, which has benefited from a catalytic investment in community level service provision.

Prevention: a shared commitment: making the case for a Prevention Transformation Fund


This document identifies and collates key pieces of evidence about the cost effectiveness of prevention in order to make the case for greater investment in prevention interventions. The report recommends that the Government should introduce a Prevention Transformation Fund, worth at least £2 billion annually. This would enable some double running of new investment in preventative services alongside ‘business as usual’ in the current system, until savings can be realised and reinvested into the system – as part of wider local prevention strategies. Based on the analysis of an extensive range of intervention case studies that have provided a net cost benefit, the report suggests that investment in prevention could yield a net return of 90 per cent.

Building community capacity: the economic case in adult social care in England


This briefing summarises the findings of a study to establish the costs, outputs and outcomes of a number of four best practice community capacity-building projects, especially in relation to their potential for alleviating pressures on adult social care budgets and in the context of current policy interests. All projects worked under financial uncertainties and these challenges highlighted a poor fit between third sector infrastructures and the public sector’s growing requirements for targeted, evidence-based investments. The four projects evaluated comprised support services for people with disabilities, a help-at-home scheme for older people, a training scheme to produce local health champions and a peer-support project for people with mental health issues. Such third sector approaches may postpone or replace formal social care, but projects found it difficult to meet demands for data, whether for making a business case or for the purposes of research. The study found that well-targeted schemes have the potential to produce both benefits to participants and substantial savings to public agencies. Yet the current commissioning context tends to encourage organisations to focus on established priorities rather than to develop innovative, community-based services.

Assessing social care market and provider sustainability: part A: a guide for local authorities


The Care Act 2014 introduces a regime to oversee the financial stability of the hardest-to-replace care providers, and sets out measures to ensure people’s care is not interrupted if any social care or support providers fail. This guidance aims to help local authorities to fulfil their responsibilities in the event of provider failure by: helping them identify whether the failure of a provider will leave people at risk of being without a means of having their care and support needs met; where there is a risk, identifying those providers who are most important to meeting those needs, and; where the critical or hardest to replace providers are not within the Care Quality Commission Market Oversight Regime, assessing and taking action to reduce the risk of failure or the impact of a failure should one occur. The document begins looking at care markets and providers, introducing a suggested approach to categorising and segmenting care markets, as well as outlining the main reasons for provider failure. It then considers how to identify indicators of market sustainability and how to monitor hard-to-replace providers.

Assessing social care market and provider sustainability: part B: toolkit


Provides a framework to help local authorities implement a test of care market sustainability, and offers insights about when a provider requires further monitoring. Many local authorities have developed highly effective systems for gathering local market intelligence in relation to the part of the market with which they contract for services. This intelligence may be gathered both formally and informally and involve a broad range of approaches. This toolkit is designed to complement such approaches by providing a clear structure for local authorities to consider the totality of the local market, only a proportion of which they will directly contract with. There are five phases to the application of the toolkit: determining local market segmentation; evaluation of external indicators; evaluation of sub market composition indicators; forming a judgement on sustainability and deciding which ‘hard to replace’ providers to monitor; and understanding and monitoring the sustainability of ’hard to replace’ providers.

Results 1 - 10 of 17


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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