Economic Evaluation of Social Care Interventions: Lessons Drawn from a Systematic Review of the Methods Used to Evaluate Reablement

Reablement helps individuals to regain or retain the ability to live independently after an injury and/or exacerbation of an illness. Despite the lack of clear evidence on its effectiveness and cost-effectiveness, or on the optimal model for its implementation, reablement is hailed as one solution to the increased demand for long term care. This study systematically reviews, synthesises and critically appraises the economic evidence on reablement, and makes recommendations to improve future research. A total of 13 studies were included. Data were extracted on: decision, context, study design, intervention, comparators, effectiveness, outcomes, resource use and costs, analytic methods, and study findings. Reablement has been shown to be cost-effective; however the reporting on the decision the study aims to inform and the context could typically be improved and there is uncertainty on the costs and benefits of reablement in the longer term, between different models of service delivery and the impact on carers. All studies used only the data on outcomes and costs that was collected within the study and evaluated cost-effectiveness over the data collection follow-up, but this approach was not justified. These methods results should inform future research. Economic evaluations on reablement should: (i) include all available evidence on the relevant interventions and comparators over the appropriate time horizon, (ii) compare the benefits of the intervention with its opportunity costs and (iii) consider subgroup analysis to identify the groups of individuals most likely to benefit from reablement and therefore better target interventions and resources. More methodological research and guidance is needed on standardised outcome measures on general wellbeing, on informal carer’s burden and on how to trade-off the costs and benefits in different sectors. These recommendations can help improve quality and relevance for decision makers in the future and to guide future economic evaluations and methodological research.