TY - JOUR

T1 - Access to health care for older people with intellectual disability

T2 - A modelling study to explore the cost-effectiveness of health checks

AU - Bauer, A.

AU - Taggart, L.

AU - Rasmussen, J.

AU - Hatton, C.

AU - Owen, L.

AU - Knapp, M.

N1 - Export Date: 20 June 2019 Correspondence Address: Bauer, A.; Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, United Kingdom; email: A.bauer@lse.ac.uk Funding details: National Institute for Health and Care Excellence Funding text 1: This work was produced as part of a national guideline for the National Institute for Health and Care Excellence (NICE), which was the sole sponsor of this study. NICE had no role in study design, data collection, or data interpretation. NICE provided technical advice in writing the report; this was restricted to comments concerning the quality of reporting and did not include aspects pertinent to the contents of the study. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. Funding text 2: This work was a collaboration led by researchers (AB, MK) at the Personal Social Services Research Unit at the London School of Economics and Political Science working with two committee members (JR, LT) and one advisor (LO) from the National Institute for Health and Care Excellence (NICE) guideline ‘Care and support for people growing older with learning disability’ and one expert (CH) from the Centre for Disability Research at Lancaster University. AB with experience in economic evaluations in the prevention area in health and social care carried out the economic modelling and led on writing the abstract and paper; LT contributed with his clinical research and health promotion expertise in the area of intellectual disability to the modelling, writing of the abstract and paper; JR contributed with her clinical expertise in primary care, intellectual disabilities, mental health and dementia to the modelling, writing of the abstract and paper; CH contributed with his expertise in public health data and approaches to people with intellectual disabilities to writing the abstract and paper; LO contributed with her expertise as technical advisor for NICE public health guidelines to technical aspects in writing of the abstract and paper; MK provided overarching advice and comments to the overall process contributing in particular to the economic rigor and policy discussion of the study. All authors have read and approved the manuscript.

PY - 2019/6/7

Y1 - 2019/6/7

N2 - Background: Whilst people with intellectual disability grow older, evidence has emerged internationally about the largely unmet health needs of this specific ageing population. Health checks have been implemented in some countries to address those health inequalities. Evaluations have focused on measuring process outcomes due to challenges measuring quality of life outcomes. In addition, the cost-effectiveness is currently unknown. As part of a national guideline for this population we sought to explore the likely cost-effectiveness of annual health checks in England. Methods: Decision-analytical Markov modelling was used to estimate the cost-effectiveness of a strategy, in which health checks were provided for older people with intellectual disability, when compared with standard care. The approach we took was explorative. Individual models were developed for a selected range of health conditions, which had an expected high economic impact and for which sufficient evidence was available for the modelling. In each of the models, hypothetical cohorts were followed from 40 yrs. of age until death. The outcome measure was cost per quality-adjusted life-year (QALY) gained. Incremental cost-effectiveness ratios (ICER) were calculated. Costs were assessed from a health provider perspective and expressed in 2016 GBP. Costs and QALYs were discounted at 3.5%. We carried out probabilistic sensitivity analysis. Data from published studies as well as expert opinion informed parameters. Results: Health checks led to a mean QALY gain of 0.074 (95% CI 0.072 to 0.119); and mean incremental costs of £4787 (CI 95% 4773 to 5017). For a threshold of £30,000 per QALY, health checks were not cost-effective (mean ICER £85,632; 95% CI 82,762 to 131,944). Costs of intervention needed to reduce from £258 to under £100 per year in order for health checks to be cost-effective. Conclusion: Whilst findings need to be considered with caution as the model was exploratory in that it was based on assumptions to overcome evidence gaps, they suggest that the way health systems deliver care for vulnerable populations might need to be re-examined. The work was carried out as part of a national guideline and informed recommendations about system changes to achieve more equal health care provisions. © 2019 The Author(s).

AB - Background: Whilst people with intellectual disability grow older, evidence has emerged internationally about the largely unmet health needs of this specific ageing population. Health checks have been implemented in some countries to address those health inequalities. Evaluations have focused on measuring process outcomes due to challenges measuring quality of life outcomes. In addition, the cost-effectiveness is currently unknown. As part of a national guideline for this population we sought to explore the likely cost-effectiveness of annual health checks in England. Methods: Decision-analytical Markov modelling was used to estimate the cost-effectiveness of a strategy, in which health checks were provided for older people with intellectual disability, when compared with standard care. The approach we took was explorative. Individual models were developed for a selected range of health conditions, which had an expected high economic impact and for which sufficient evidence was available for the modelling. In each of the models, hypothetical cohorts were followed from 40 yrs. of age until death. The outcome measure was cost per quality-adjusted life-year (QALY) gained. Incremental cost-effectiveness ratios (ICER) were calculated. Costs were assessed from a health provider perspective and expressed in 2016 GBP. Costs and QALYs were discounted at 3.5%. We carried out probabilistic sensitivity analysis. Data from published studies as well as expert opinion informed parameters. Results: Health checks led to a mean QALY gain of 0.074 (95% CI 0.072 to 0.119); and mean incremental costs of £4787 (CI 95% 4773 to 5017). For a threshold of £30,000 per QALY, health checks were not cost-effective (mean ICER £85,632; 95% CI 82,762 to 131,944). Costs of intervention needed to reduce from £258 to under £100 per year in order for health checks to be cost-effective. Conclusion: Whilst findings need to be considered with caution as the model was exploratory in that it was based on assumptions to overcome evidence gaps, they suggest that the way health systems deliver care for vulnerable populations might need to be re-examined. The work was carried out as part of a national guideline and informed recommendations about system changes to achieve more equal health care provisions. © 2019 The Author(s).

KW - Ageing

KW - Assessment

KW - Cost-effectiveness

KW - Decision-analytic modelling

KW - Early diagnosis

KW - Health checks

KW - Health inequalities

KW - Intellectual disability

KW - Prevention

U2 - 10.1186/s12889-019-6912-0

DO - 10.1186/s12889-019-6912-0

M3 - Journal article

VL - 19

JO - BMC Public Health

JF - BMC Public Health

SN - 1471-2458

IS - 1

M1 - 706

ER -