Scoping review on social care economic evaluation methods

Background: In the UK and internationally there is widespread acceptance of the value of economic evaluations to inform decisions about health care  interventions. The general methods of economic evaluation of health care interventions are now well established. By contrast, approaches to social care economic evaluation are substantially less well developed. There is considerable uncertainty and disagreement about which methods to apply, and diversity in methodological practices. This makes it hard for decision makers to interpret the findings of different studies and make comparisons of value for money between different interventions evaluated using different methods. Despite previous attempts to co-ordinate methods in this area by providing guidelines (NICE, 2013, NICE, 2014), there remains considerable methodological uncertainty. NICE commissioned this scoping review to support developing a long-term strategy for how to consider social care economics in guidelines. Aims: The project aims to inform NICE on the methods available and the methods in development for use in undertaking economic evaluation of social care interventions. A further aim of the scoping review is to assess how well these methods address current methodological priorities for NICE in social care economic evaluation, and to identify gaps that the work will not address. On this basis, another aim is to provide recommendations to NICE on work required to address identified gaps in the future. Methods: A systematic review of the published literature and a survey of experts were undertaken to identify key methods used to undertake recent economic evaluations of social care interventions. Each study was assessed in terms of the key requirements for economic evaluation. Data were extracted on: the perspective of the analysis, the interventions compared, the evidence used on costs and effects, opportunity cost, uncertainty, and equity. Expert advisors commented on the findings of the review and this informed the results that were drawn from the studies. Recommendations were made to improve the conduct and reporting of studies, and areas of further research were identified. Results: Thirty social care economic evaluations were identified for review. Findings were reported on key requirements for economic evaluation comprising: the perspective of relevance to the decision maker, an evaluation comparing all relevant alternative interventions, use of all available evidence on costs and effects of relevance to the decision, analysis of whether the benefits of an intervention were greater than the forgone benefits of displaced interventions, assessment of the uncertainty associated with the decision, and exploration of the equity implications of the decision. Conclusions: Methods guidance for the economic evaluation of social care interventions needs to reflect what is feasible given the available evidence and what is appropriate for social care. A more developed evidence base is required in order to undertake economic evaluation of social care interventions. This should include undertaking primary studies where the evidence is not sufficient. Studies based on decision models and secondary evidence should be used where there is sufficient evidence available to do so. Investment in applied economic evaluations of social care interventions will support more informed recommendations and also develop research capacity in social care. Further methodological research is required to improve the way economic evaluations are undertaken in this field. This includes:  agreement on the objectives of social care and the appropriate outcome measures  development of cost-effectiveness threshold in social care given the agreed outcome measures  how to account for costs and benefits falling on different sectors  accounting for informal care  equity-informative economic evaluations of social care interventions  better scoping of economic evaluations  application of evidence synthesis, decision modelling and expert elicitation  application of value of information methods. NICE should consider these priorities in their discussions with the MRC Methodology Research Programme, to establish whether it can commission research on some or all of these areas.