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An economic evaluation of an integrated care pathway in geriatric rehabilitation for older patients with complex health problems

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  • Irma H J Everink
  • Jolanda C M van Haastregt
  • Silvia M A A Evers
  • Gertrudis I J M Kempen
  • Jos M G A Schols

Abstract

Background: Integrated care pathways which cover multiple care settings are increasingly used as a tool to structure care, enhance coordination and improve transitions between care settings. However, little is known about their economic impact. The objective of this study is to determine the cost-effectiveness and cost-utility of an integrated care pathway designed for patients with complex health problems transferring from the hospital, a geriatric rehabilitation facility and primary care. Methods: This economic evaluation was performed from a societal perspective alongside a prospective cohort study with two cohorts of patients. The care as usual cohort was included before implementation of the pathway and the care pathway cohort after implementation of the pathway. Both cohorts were measured over nine months, during which intervention costs, healthcare costs, patient and family costs were identified. The outcome measures were dependence in activities of daily living (measured with the KATZ-15) and quality adjusted life years (EQ-5D-3L). Costs and effects were bootstrapped and various sensitivity analyses were performed to assess robustness of the results. Results: After nine months, the average societal costs were significantly lower for patients in the care pathway cohort (€50,791) versus patients in the care as usual cohort (€62,170; CI = -22,090, -988). Patients in the care pathway cohort had better scores on the KATZ-15 (1.04), indicating cost-effectiveness. No significant differences were found between the two groups on QALY scores (0.01). Conclusions: The results of this study indicate that the integrated care pathway is a cost-effective intervention. Therefore, dissemination of the integrated care pathway on a wider scale could be considered. This would provide us the opportunity to confirm the findings of our study in larger economic evaluations. When looking at QALYs, no effects were found. Therefore, it is also recommended to explore if therapy in geriatric rehabilitation could also pay attention to other quality of life-related domains, such as mood and social participation.

Suggested Citation

  • Irma H J Everink & Jolanda C M van Haastregt & Silvia M A A Evers & Gertrudis I J M Kempen & Jos M G A Schols, 2018. "An economic evaluation of an integrated care pathway in geriatric rehabilitation for older patients with complex health problems," PLOS ONE, Public Library of Science, vol. 13(2), pages 1-21, February.
    • Handle: RePEc:plo:pone00:0191851
    DOI: 10.1371/journal.pone.0191851
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    References listed on IDEAS

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    1. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
    2. Marike R. C. Hendriks & Maiwenn J. Al & Michel H. C. Bleijlevens & Jolanda C. M. van Haastregt & Harry F. J. M. Crebolder & Jacques Th. M. van Eijk & Silvia M. A. A. Evers, 2013. "Continuous versus Intermittent Data Collection of Health Care Utilization," Medical Decision Making, , vol. 33(8), pages 998-1008, November.
    3. Don Husereau & Michael Drummond & Stavros Petrou & Chris Carswell & David Moher & Dan Greenberg & Federico Augustovski & Andrew Briggs & Josephine Mauskopf & Elizabeth Loder, 2013. "Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(3), pages 367-372, June.
    4. Gerald Richardson & Andrea Manca, 2004. "Calculation of quality adjusted life years in the published literature: a review of methodology and transparency," Health Economics, John Wiley & Sons, Ltd., vol. 13(12), pages 1203-1210, December.
    5. Deneckere, Svin & Euwema, Martin & Van Herck, Pieter & Lodewijckx, Cathy & Panella, Massimiliano & Sermeus, Walter & Vanhaecht, Kris, 2012. "Care pathways lead to better teamwork: Results of a systematic review," Social Science & Medicine, Elsevier, vol. 75(2), pages 264-268.
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