Economic and ethical implications of improving access to health care for older people with intellectual disabilities in England: a cost-effectiveness modelling study of health checks

Annette Bauer, Laurence Taggart, Jill Rasmussen, Chris Hatton, Lesely Owen, Martin Knapp

Research output: Contribution to journalArticle

Abstract

Background An increasing number of people with intellectual disabilities are reaching old age. Knowledge has emerged internationally about the complex and largely unmet health needs of this specific ageing population, and associated costs. Annual health checks, incentivised but not mandatory for primary care in England, seek to reduce health inequities for this population. However, their cost-effectiveness is unknown. Our study aimed to address this evidence gap.Methods We developed a decision analytical Markov model to compare a strategy in which older people with intellectual disabilities received annual health checks with standard care. The model, developed to inform a guideline for the National Institute for Health and Care Excellence (NICE), followed hypothetical cohorts of 1000 people in England from when they were 40 years old until they died. Outcome measure was cost per quality-adjusted life-year (QALY) gained. We calculated incremental cost-effectiveness ratios (ICER). Costs were assessed from a health provider perspective and expressed in 2016 British pounds. Costs and QALYs were discounted at 3·5%. We carried out probabilistic sensitivity analysis. Data from published studies as well as expert opinions informed parameters.Findings Annual health checks led to a mean QALY gain of 0·072 (95% CI 0·069–0·113) and mean incremental costs of £4911 (4897–5133). For a threshold of £30 000, annual health checks were not cost effective (mean ICER £89 200, 95% CI 86 252 to 136 769). Costs of intervention needed to reduce from £258 to under £100 per year for annual health checks to be cost effective.Interpretation Although our findings need to be considered with caution since the model was based on assumptions to overcome evidence gaps, they suggest that providing cost-effective annual health checks is difficult. This immediately raises ethical questions about equitable access to heal
LanguageEnglish
JournalThe Lancet
Volume390
Issue numberS4
Early online date23 Nov 2017
DOIs
Publication statusE-pub ahead of print - 23 Nov 2017

Fingerprint

Health Services Accessibility
Disabled Persons
Intellectual Disability
England
Cost-Benefit Analysis
Economics
Costs and Cost Analysis
Health
Quality-Adjusted Life Years
National Institutes of Health (U.S.)
Expert Testimony
Population
Primary Health Care
Outcome Assessment (Health Care)
Guidelines
Delivery of Health Care

Keywords

  • intellectual disabilities
  • health checks
  • cost-effectiveness

Cite this

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title = "Economic and ethical implications of improving access to health care for older people with intellectual disabilities in England: a cost-effectiveness modelling study of health checks",
abstract = "Background An increasing number of people with intellectual disabilities are reaching old age. Knowledge has emerged internationally about the complex and largely unmet health needs of this specific ageing population, and associated costs. Annual health checks, incentivised but not mandatory for primary care in England, seek to reduce health inequities for this population. However, their cost-effectiveness is unknown. Our study aimed to address this evidence gap.Methods We developed a decision analytical Markov model to compare a strategy in which older people with intellectual disabilities received annual health checks with standard care. The model, developed to inform a guideline for the National Institute for Health and Care Excellence (NICE), followed hypothetical cohorts of 1000 people in England from when they were 40 years old until they died. Outcome measure was cost per quality-adjusted life-year (QALY) gained. We calculated incremental cost-effectiveness ratios (ICER). Costs were assessed from a health provider perspective and expressed in 2016 British pounds. Costs and QALYs were discounted at 3·5{\%}. We carried out probabilistic sensitivity analysis. Data from published studies as well as expert opinions informed parameters.Findings Annual health checks led to a mean QALY gain of 0·072 (95{\%} CI 0·069–0·113) and mean incremental costs of £4911 (4897–5133). For a threshold of £30 000, annual health checks were not cost effective (mean ICER £89 200, 95{\%} CI 86 252 to 136 769). Costs of intervention needed to reduce from £258 to under £100 per year for annual health checks to be cost effective.Interpretation Although our findings need to be considered with caution since the model was based on assumptions to overcome evidence gaps, they suggest that providing cost-effective annual health checks is difficult. This immediately raises ethical questions about equitable access to heal",
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Economic and ethical implications of improving access to health care for older people with intellectual disabilities in England: a cost-effectiveness modelling study of health checks. / Bauer, Annette; Taggart, Laurence; Rasmussen, Jill; Hatton, Chris; Owen, Lesely; Knapp, Martin.

In: The Lancet, Vol. 390, No. S4, 23.11.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Economic and ethical implications of improving access to health care for older people with intellectual disabilities in England: a cost-effectiveness modelling study of health checks

AU - Bauer, Annette

AU - Taggart, Laurence

AU - Rasmussen, Jill

AU - Hatton, Chris

AU - Owen, Lesely

AU - Knapp, Martin

PY - 2017/11/23

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N2 - Background An increasing number of people with intellectual disabilities are reaching old age. Knowledge has emerged internationally about the complex and largely unmet health needs of this specific ageing population, and associated costs. Annual health checks, incentivised but not mandatory for primary care in England, seek to reduce health inequities for this population. However, their cost-effectiveness is unknown. Our study aimed to address this evidence gap.Methods We developed a decision analytical Markov model to compare a strategy in which older people with intellectual disabilities received annual health checks with standard care. The model, developed to inform a guideline for the National Institute for Health and Care Excellence (NICE), followed hypothetical cohorts of 1000 people in England from when they were 40 years old until they died. Outcome measure was cost per quality-adjusted life-year (QALY) gained. We calculated incremental cost-effectiveness ratios (ICER). Costs were assessed from a health provider perspective and expressed in 2016 British pounds. Costs and QALYs were discounted at 3·5%. We carried out probabilistic sensitivity analysis. Data from published studies as well as expert opinions informed parameters.Findings Annual health checks led to a mean QALY gain of 0·072 (95% CI 0·069–0·113) and mean incremental costs of £4911 (4897–5133). For a threshold of £30 000, annual health checks were not cost effective (mean ICER £89 200, 95% CI 86 252 to 136 769). Costs of intervention needed to reduce from £258 to under £100 per year for annual health checks to be cost effective.Interpretation Although our findings need to be considered with caution since the model was based on assumptions to overcome evidence gaps, they suggest that providing cost-effective annual health checks is difficult. This immediately raises ethical questions about equitable access to heal

AB - Background An increasing number of people with intellectual disabilities are reaching old age. Knowledge has emerged internationally about the complex and largely unmet health needs of this specific ageing population, and associated costs. Annual health checks, incentivised but not mandatory for primary care in England, seek to reduce health inequities for this population. However, their cost-effectiveness is unknown. Our study aimed to address this evidence gap.Methods We developed a decision analytical Markov model to compare a strategy in which older people with intellectual disabilities received annual health checks with standard care. The model, developed to inform a guideline for the National Institute for Health and Care Excellence (NICE), followed hypothetical cohorts of 1000 people in England from when they were 40 years old until they died. Outcome measure was cost per quality-adjusted life-year (QALY) gained. We calculated incremental cost-effectiveness ratios (ICER). Costs were assessed from a health provider perspective and expressed in 2016 British pounds. Costs and QALYs were discounted at 3·5%. We carried out probabilistic sensitivity analysis. Data from published studies as well as expert opinions informed parameters.Findings Annual health checks led to a mean QALY gain of 0·072 (95% CI 0·069–0·113) and mean incremental costs of £4911 (4897–5133). For a threshold of £30 000, annual health checks were not cost effective (mean ICER £89 200, 95% CI 86 252 to 136 769). Costs of intervention needed to reduce from £258 to under £100 per year for annual health checks to be cost effective.Interpretation Although our findings need to be considered with caution since the model was based on assumptions to overcome evidence gaps, they suggest that providing cost-effective annual health checks is difficult. This immediately raises ethical questions about equitable access to heal

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KW - health checks

KW - cost-effectiveness

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DO - 10.1016/S0140-6736

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VL - 390

JO - Lancet

T2 - Lancet

JF - Lancet

SN - 0140-6736

IS - S4

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