Background: Economic evaluation is a framework to assess the value for money of interventions provided within a budget-constrained system. Applied to social (long-term) care, it assesses the costs and outcomes of comparable interventions against other uses if the same resources were used elsewhere in social care. The number of economic evaluations of social care interventions continues to increase. NICE, UK, has supported this by producing methods guidance for the economic evaluation of social care interventions. Social care interventions are complex interventions. The context in which social care is delivered and funded shapes the opportunities and challenges for undertaking economic analysis.
Objectives: This presentation summarises the study design and analytic methods used to undertake three disparate adult social care economic evaluations. It summarises challenges in the collection and use of primary data to produce cost-effectiveness evidence to inform decision makers. It reflects on the lessons learned in undertaking these evaluations, providing insights for undertaking future economic evaluations of social care interventions.
Methods: A summary is presented of the study design and analytic methods used to undertake an economic evaluation of (i) a specialist nurse intervention to support carers of people with dementia, (ii) an in-house versus contracted-out service providing vision rehabilitation to people with severe sight loss, and (iii) a hearing dog intervention to support people with severe hearing loss. Advantages and disadvantages of using different study designs are discussed in the context within which each study was undertaken, and the implications of the different study designs for the analytic methods chosen. A discussion follows about the type of economic evaluation applied in each study, and the use of NICE methods guidance for economic evaluations of interventions with a social care focus.
Results: A range of study designs and analytic methods were used to undertake the studies. The specialist nurse study used a cross-sectional survey design, the vision rehabilitation study used a prospective comparative cohort study and the hearing dog study used a randomised controlled trial design. Use of the economic evaluations to inform different stakeholder perspectives (i.e., social care perspective, health care perspective and, social care and health care perspectives) meant that in two of the studies more than one economic evaluation was undertaken.
Conclusions: The study designs and analytic methods used in the studies reflected a balance between a pragmatic approach to collecting and using data given the intervention for analysis, and the setting and research context in which the intervention was provided, as well as the aim of undertaking as well-controlled and rigorous evaluations as possible within the project budget. Typically, trials are chosen as the gold standard approach to assess an intervention's effectiveness, although this is not common in social care research. Well-designed observational studies also have a contribution to make and should be included in the debate.