Cost and effects of integrated care: a systematic literature review and meta-analysis

Governments across high-income countries are challenged to contain the relentless increase in health expenditure, which is partly driven by ageing populations and an associated increase in the prevalence of chronic disease. This challenge is increasingly concerning as many health systems have become highly specialised, fragmented and poorly set to manage the growing burden of multimorbidity. Increasing efficiency in care delivery by integrating health services has been proposed as a solution to healthcare budget issues. Integrated care is an umbrella term that encompasses a diverse set of methods and models that facilitate improvement in patient experience through enhanced coordination and continuity of care. As such, integrated care covers a wide range of treatment plans and organizational models, does not discriminate between diseases or target populations, and has varied consequences across different treatment areas. The Triple Aim of integrated care is to improve population health, enhance user experience with care and reduce growing healthcare expenditure.

Despite pressure to assess the cost-effectiveness of integrated care interventions to appropriately inform decision makers of the potential financial benefits of moving towards new models of care, the evidence from economic evaluations has thus far been inconclusive. This is widely attributed to the lack of reliable evidence summarized by Nolte and colleagues (2014) who identified the “quality of existing economic evaluations as the main impediment to arriving at robust evidence to inform decision making” . Indeed, a recent systematic literature review showed that economic evaluations in integrated care had on average poor-to-moderate methodological quality [18]. In addition, the unclear definition of what constitutes integrated care and the large variation in the models of integration within and across geographic areas poses a challenge to the reliability and replicability of evaluation studies.

Currently, there is a dearth of meta-analyses of economic evaluations that compare integrated care models with conventional care; this evidence focuses on single conditions and certain models of integrated care. In addition to the limited span of evidence, the overall impact of integrated care on costs and outcomes is still unclear. This paper aims to provide an up-to-date review of economic evaluations in integrated care and perform a meta-analysis to summarize the impact of integrated care on costs and outcomes.