Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Polibienestar Research Institute, Universitat de València, Valencia, Spain.
Eur J Health Econ. 2020 Nov;21(8):1211-1221. doi: 10.1007/s10198-020-01217-5. Epub 2020 Jul 6.
Health and care services are becoming increasingly strained and healthcare authorities worldwide are investing in integrated care in the hope of delivering higher-quality services while containing costs. The cost-effectiveness of integrated care, however, remains unclear. This systematic review and meta-analysis aims to appraise current economic evaluations of integrated care and assesses the impact on outcomes and costs.
CINAHL, DARE, EMBASE, Medline/PubMed, NHS EED, OECD Library, Scopus, Web of Science, and WHOLIS databases from inception to 31 December 2019 were searched to identify studies assessing the cost-effectiveness of integrated care. Study quality was assessed using an adapted CHEERS checklist and used as weight in a random-effects meta-analysis to estimate mean cost and mean outcomes of integrated care.
Selected studies achieved a relatively low average quality score of 65.0% (± 18.7%). Overall meta-analyses from 34 studies showed a significant decrease in costs (0.94; CI 0.90-0.99) and a statistically significant improvement in outcomes (1.06; CI 1.05-1.08) associated with integrated care compared to the control. There is substantial heterogeneity in both costs and outcomes across subgroups. Results were significant in studies lasting over 12 months (12 studies), with both a decrease in cost (0.87; CI 0.80-0.94) and improvement in outcomes (1.15; 95% CI 1.11-1.18) for integrated care interventions; whereas, these associations were not significant in studies with follow-up less than a year.
Our findings suggest that integrated care is likely to reduce cost and improve outcome. However, existing evidence varies largely and is of moderate quality. Future economic evaluation should target methodological issues to aid policy decisions with more robust evidence on the cost-effectiveness of integrated care.
健康和保健服务正面临越来越大的压力，全球医疗保健当局正在投资整合护理，希望在控制成本的同时提供更高质量的服务。然而，整合护理的成本效益仍不清楚。本系统评价和荟萃分析旨在评估整合护理的当前经济评估，并评估对结果和成本的影响。
从成立到 2019 年 12 月 31 日，检索了 CINAHL、DARE、EMBASE、Medline/PubMed、NHS EED、OECD 图书馆、Scopus、Web of Science 和 WHOLIS 数据库，以确定评估整合护理成本效益的研究。使用经过修改的 CHEERS 清单评估研究质量，并将其用作随机效应荟萃分析的权重，以估算整合护理的平均成本和平均结果。
入选的研究平均质量得分相对较低，为 65.0%（±18.7%）。34 项研究的总体荟萃分析显示，与对照组相比，整合护理可显著降低成本（0.94；CI 0.90-0.99）和改善结果（1.06；CI 1.05-1.08）。成本和结果在亚组之间存在很大的异质性。在持续时间超过 12 个月的 12 项研究中，成本（0.87；CI 0.80-0.94）和结果（1.15；95%CI 1.11-1.18）的改善均与整合护理干预相关，结果具有统计学意义；而在随访时间不到一年的研究中，这些关联则不显著。
我们的研究结果表明，整合护理可能会降低成本并改善结果。然而，现有证据差异很大，质量也不高。未来的经济评估应针对方法学问题，以提供更有力的证据，帮助决策者做出有关整合护理成本效益的决策。
