IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0191851.html
   My bibliography  Save this article

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

Author

Listed:
  • 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
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0191851
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0191851&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0191851?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. 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.
    2. 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," PharmacoEconomics, Springer, vol. 31(5), pages 361-367, May.
    3. 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.
    4. 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.
    5. 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.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Saha, Sanjib & Gerdtham, Ulf-G. & Toresson, Håkan & Minthon, Lennart & Jarl, Johan, 2018. "Economic Evaluation of Interventions for Screening of Dementia," Working Papers 2018:20, Lund University, Department of Economics.
    2. Najmiatul Fitria & Antoinette D. I. Asselt & Maarten J. Postma, 2019. "Cost-effectiveness of controlling gestational diabetes mellitus: a systematic review," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(3), pages 407-417, April.
    3. Thomas Grochtdreis & Hans-Helmut König & Alexander Dobruschkin & Gunhild von Amsberg & Judith Dams, 2018. "Cost-effectiveness analyses and cost analyses in castration-resistant prostate cancer: A systematic review," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-25, December.
    4. Saha, Sanjib & Gerdtham, Ulf-G. & Toresson, Håkan & Minthon, Lennart & Jarl, Johan, 2018. "Economic Evaluation of Nonpharmacological Interventions for Dementia Patients and their Caregivers - A Systematic Literature Review," Working Papers 2018:10, Lund University, Department of Economics.
    5. Jesse Elliott & Sasha Katwyk & Bláthnaid McCoy & Tammy Clifford & Beth K. Potter & Becky Skidmore & George A. Wells & Doug Coyle, 2019. "Decision Models for Assessing the Cost Effectiveness of Treatments for Pediatric Drug-Resistant Epilepsy: A Systematic Review of Economic Evaluations," PharmacoEconomics, Springer, vol. 37(10), pages 1261-1276, October.
    6. Wei Zhang & Aslam Anis, 2014. "Health-Related Productivity Loss: NICE to Recognize Soon, Good to Discuss Now," PharmacoEconomics, Springer, vol. 32(5), pages 425-427, May.
    7. Rachael Hunter & Gianluca Baio & Thomas Butt & Stephen Morris & Jeff Round & Nick Freemantle, 2015. "An Educational Review of the Statistical Issues in Analysing Utility Data for Cost-Utility Analysis," PharmacoEconomics, Springer, vol. 33(4), pages 355-366, April.
    8. Don Husereau & Michael Drummond & Stavros Petrou & Dan Greenberg & Josephine Mauskopf & Federico Augustovski & Andrew Briggs & David Moher & Elizabeth Loder & Chris Carswell, 2015. "Reply to Roberts et al.: CHEERS is Sufficient for Reporting Cost-Benefit Analysis, but May Require Further Elaboration," PharmacoEconomics, Springer, vol. 33(5), pages 535-536, May.
    9. Neily Zakiyah & Antoinette D I van Asselt & Frank Roijmans & Maarten J Postma, 2016. "Economic Evaluation of Family Planning Interventions in Low and Middle Income Countries; A Systematic Review," PLOS ONE, Public Library of Science, vol. 11(12), pages 1-19, December.
    10. Kathryn Schnippel & Naomi Lince-Deroche & Theo van den Handel & Seithati Molefi & Suann Bruce & Cynthia Firnhaber, 2015. "Cost Evaluation of Reproductive and Primary Health Care Mobile Service Delivery for Women in Two Rural Districts in South Africa," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-13, March.
    11. Andrea Iannaccone & Thomas Marwick, 2015. "Cost Effectiveness of Transcatheter Aortic Valve Replacement Compared with Medical Management or Surgery for Patients with Aortic Stenosis," Applied Health Economics and Health Policy, Springer, vol. 13(1), pages 29-45, February.
    12. Rachel Elliott & Koen Putman & James Davies & Lieven Annemans, 2014. "A Review of the Methodological Challenges in Assessing the Cost Effectiveness of Pharmacist Interventions," PharmacoEconomics, Springer, vol. 32(12), pages 1185-1199, December.
    13. Paul Tappenden & James Chilcott, 2014. "Avoiding and Identifying Errors and Other Threats to the Credibility of Health Economic Models," PharmacoEconomics, Springer, vol. 32(10), pages 967-979, October.
    14. S. Rajsic & H. Gothe & H. H. Borba & G. Sroczynski & J. Vujicic & T. Toell & Uwe Siebert, 2019. "Economic burden of stroke: a systematic review on post-stroke care," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(1), pages 107-134, February.
    15. Maximilian Hatz & Reiner Leidl & Nichola Yates & Björn Stollenwerk, 2014. "A Systematic Review of the Quality of Economic Models Comparing Thrombosis Inhibitors in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention," PharmacoEconomics, Springer, vol. 32(4), pages 377-393, April.
    16. Stuart Wright & Cheryl Jones & Katherine Payne & Nimarta Dharni & Fiona Ulph, 2015. "The Role of Information Provision in Economic Evaluations of Newborn Bloodspot Screening: A Systematic Review," Applied Health Economics and Health Policy, Springer, vol. 13(6), pages 615-626, December.
    17. Georgina Jones & Victoria Brennan & Richard Jacques & Hilary Wood & Simon Dixon & Stephen Radley, 2018. "Evaluating the impact of a ‘virtual clinic’ on patient experience, personal and provider costs of care in urinary incontinence: A randomised controlled trial," PLOS ONE, Public Library of Science, vol. 13(1), pages 1-16, January.
    18. Susanne Mayer & Noemi Kiss & Agata Łaszewska & Judit Simon, 2017. "Costing evidence for health care decision-making in Austria: A systematic review," PLOS ONE, Public Library of Science, vol. 12(8), pages 1-18, August.
    19. Naomi Lince-Deroche & Jane Phiri & Pam Michelow & Jennifer S Smith & Cindy Firnhaber, 2015. "Costs and Cost Effectiveness of Three Approaches for Cervical Cancer Screening among HIV-Positive Women in Johannesburg, South Africa," PLOS ONE, Public Library of Science, vol. 10(11), pages 1-16, November.
    20. Alessandro G. Campolina & Luciana M. Rozman & Tassia C. Decimoni & Roseli Leandro & Hillegonda M. D. Novaes & Patrícia Coelho De Soárez, 2017. "Many Miles to Go: A Systematic Review of the State of Cost-Utility Analyses in Brazil," Applied Health Economics and Health Policy, Springer, vol. 15(2), pages 163-172, April.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0191851. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.