Economic evaluations of social care interventions: business as usual?

Background: Traditionally HTA agencies such as NICE make recommendations on the use of health technologies. Recently NICE’s remit has extended to social care. Increasingly the consensus is that integrating health and social care is fundamental to driving up the quality of patient care. Objectives: A review of the empirical literature was undertaken to examine economic evaluation methods for assessing social care interventions. It sought to identify whether the evaluation of these services poses particular methodological challenges, and to explore how they may be addressed. Methods: Thirteen health, care and economic bibliographic databases were searched to identify relevant literature, and experts were consulted. Data on study characteristics and key economic evaluation methods were extracted. Results: 29 studies were reviewed fully following assessment of 6,082 abstracts. Evidence from the review suggests a general lack of clarity in methodological considerations and reporting of the decision problem, perspective of the analysis and decision making context. Methodological challenges exist in the measurement and valuation of outcomes and informal carer time, assessment of multi-sector implications and equity. Most studies (79%) included more than one outcome. A variety of measures were used, even when evaluating the same intervention, complicating cross-study comparison. Informal care was evaluated in 38% of studies. All valued time using the human capital approach however a number of different wage estimates were used. 90% of studies included costs falling on the health care sector. Other, broader costs were included in 84% of studies. Equity was referred to in one study. Discussion: The review highlights key methodological challenges for the economic evaluation of social care interventions and reflects on lessons to be learnt in undertaking these analyses. Implications: Additional methodological development and greater clarity on methods for assessing the cost-effectiveness of care interventions will facilitate analysts’ ability to undertake useful evaluations for informing decision making.