Clinical Costing Solutions, Belfast, BT15 4EB, UK.
Institute of Public Health, 200 South Circular Road, Dublin 8, D08 NH90, Ireland.
BMC Public Health. 2023 Dec 13;23(1):2496. doi: 10.1186/s12889-023-17369-x.
As the population ages, older people account for a larger proportion of the health and social care budget. A significant body of evidence suggests that arts and creativity interventions can improve the physical, mental and social wellbeing of older adults, however the value and/or cost-effectiveness of such interventions remains unclear.
We systematically reviewed the economic evidence relating to such interventions, reporting our findings according to PRISMA guidelines. We searched bibliographic databases (MEDLINE, EMBASE, Econlit and Web of Science and NHSEED), trial registries and grey literature. No language or temporal restrictions were applied. Two screening rounds were conducted independently by health economists experienced in systematic literature review. Methodological quality was assessed, and key information extracted and tabulated to provide an overview of the published literature. A narrative synthesis without meta-analysis was conducted.
Only six studies were identified which provided evidence relating to the value or cost-effectiveness of arts and creativity interventions to improve health and wellbeing in older adults. The evidence which was identified was encouraging, with five out of the six studies reporting an acceptable probability of cost-effectiveness or positive return on investment (ranging from £1.20 to over £8 for every £1 of expenditure). However, considerable heterogeneity was observed with respect to study participants, design, and outcomes assessed. Of particular concern were potential biases inherent in social value analyses.
Despite many studies reporting positive health and wellbeing benefits of arts and creativity interventions in this population, we found meagre evidence on their value or cost-effectiveness. Such evidence is costly and time-consuming to generate, but essential if innovative non-pharmacological interventions are to be introduced to minimise the burden of illness in this population and ensure efficient use of public funds. The findings from this review suggests that capturing data on the value and/or cost-effectiveness of such interventions should be prioritised; furthermore, research effort should be directed to developing evaluative methods which move beyond the confines of current health technology assessment frameworks, to capture a broader picture of 'value' more applicable to arts and creativity interventions and public health interventions more generally.
CRD42021267944 (14/07/2021).
随着人口老龄化，老年人在医疗保健预算中所占的比例越来越大。大量证据表明，艺术和创意干预措施可以提高老年人的身心健康和社会福利，然而，这些干预措施的价值和/或成本效益尚不清楚。
我们系统地回顾了与这些干预措施相关的经济证据，根据 PRISMA 指南报告我们的发现。我们检索了文献数据库（MEDLINE、EMBASE、Econlit 和 Web of Science 以及 NHSEED）、试验登记处和灰色文献。没有语言或时间限制。两位有系统文献综述经验的健康经济学家独立进行了两轮筛选。评估了方法学质量，并提取和制表关键信息，以提供已发表文献的概述。进行了无荟萃分析的叙述性综合。
仅确定了六项研究，这些研究提供了有关艺术和创意干预措施的价值或成本效益的证据，以改善老年人的健康和福祉。所确定的证据令人鼓舞，其中五项研究报告了成本效益可接受的概率或正投资回报（从每支出 1 英镑获得 1.20 英镑到超过 8 英镑不等）。然而，研究参与者、设计和评估的结果存在很大的异质性。特别值得关注的是社会价值分析中固有的潜在偏差。
尽管许多研究报告称，艺术和创意干预措施对这一人群的健康和福祉有积极影响，但我们发现有关其价值或成本效益的证据很少。此类证据的生成既昂贵又耗时，但如果要引入创新的非药物干预措施来减轻这一人群的疾病负担并确保公共资金的有效利用，则必不可少。本综述的结果表明，应优先考虑收集此类干预措施的价值和/或成本效益数据；此外，研究工作应致力于开发评估方法，超越当前卫生技术评估框架的局限，更广泛地了解“价值”，更适用于艺术和创意干预措施以及更广泛的公共卫生干预措施。
PROSPERO 注册号：CRD42021267944（2021 年 7 月 14 日）。
