May Peter, Lombard Vance Richard, Murphy Esther, O'Donovan Mary-Ann, Webb Naoise, Sheaf Greg, McCallion Philip, Stancliffe Roger, Normand Charles, Smith Valerie, McCarron Mary
Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, Dublin, Ireland
The Irish Longitdunal study on Ageing (TILDA), Trinity College Dublin, University of Dublin, Dublin, Ireland.
BMJ Open. 2019 Sep 20;9(9):e025736. doi: 10.1136/bmjopen-2018-025736.
To review systematically the evidence on the costs and cost-effectiveness of deinstitutionalisation for adults with intellectual disabilities.
Systematic review.
Adults (aged 18 years and over) with intellectual disabilities.
Deinstitutionalisation, that is, the move from institutional to community settings.
Studies were eligible if evaluating within any cost-consequence framework (eg, cost-effectiveness analysis, cost-utility analysis) or resource use typically considered to fall within the societal viewpoint (eg, cost to payers, service-users, families and informal care costs).
We searched MEDLINE, PsycINFO, CENTRAL, CINAHL, EconLit, Embase and Scopus to September 2017 and supplemented this with grey literature searches and handsearching of the references of the eligible studies. We assessed study quality using the Critical Appraisals Skills Programme suite of tools, excluding those judged to be of poor methodological quality.
Two studies were included; both were cohort studies from the payer perspective of people leaving long-stay National Health Service hospitals in the UK between 1984 and 1992. One study found that deinstitutionalisation reduced costs, one study found an increase in costs.
A wide-ranging literature review found limited evidence on costs associated with deinstitutionalisation for people with intellectual disabilities. From two studies included in the review, the results were conflicting. Significant gaps in the evidence base were observable, particularly with respect to priority populations in contemporary policy: older people with intellectual disabilities and serious medical illness, and younger people with very complex needs and challenging behaviours.
CRD42018077406.
系统回顾关于成年智障人士去机构化的成本及成本效益的证据。
系统评价。
成年（18岁及以上）智障人士。
去机构化，即从机构环境转移至社区环境。
若研究在任何成本-后果框架内（如成本效益分析、成本效用分析）进行评估，或涉及通常被认为属于社会视角的资源使用情况（如支付方成本、服务使用者成本、家庭成本及非正式护理成本），则该研究符合纳入标准。
检索了截至2017年9月的MEDLINE、PsycINFO、CENTRAL、CINAHL、EconLit、Embase和Scopus数据库，并通过灰色文献检索及对符合条件研究的参考文献进行手工检索加以补充。我们使用批判性评价技能计划工具套件评估研究质量，排除方法学质量较差的研究。
纳入两项研究；两项均为队列研究，从支付方角度研究了1984年至1992年间离开英国国民健康服务长期住院医院的患者。一项研究发现去机构化降低了成本，另一项研究发现成本增加。
一项广泛的文献综述发现，关于智障人士去机构化相关成本的证据有限。纳入综述的两项研究结果相互矛盾。证据基础存在显著差距，尤其是在当代政策中的优先人群方面：患有严重疾病的老年智障人士，以及有非常复杂需求和挑战性行为的年轻智障人士。
PROSPERO注册号：CRD42018077406。
