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Effect of deinstitutionalisation for adults with intellectual disabilities on costs: a systematic review.

ABSTRACT: OBJECTIVE:To review systematically the evidence on the costs and cost-effectiveness of deinstitutionalisation for adults with intellectual disabilities. DESIGN:Systematic review. POPULATION:Adults (aged 18 years and over) with intellectual disabilities. INTERVENTION:Deinstitutionalisation, that is, the move from institutional to community settings. PRIMARY AND SECONDARY OUTCOME MEASURES:Studies were eligible if evaluating within any cost-consequence framework (eg, cost-effectiveness analysis, cost-utility analysis) or resource use typically considered to fall within the societal viewpoint (eg, cost to payers, service-users, families and informal care costs). SEARCH:We searched MEDLINE, PsycINFO, CENTRAL, CINAHL, EconLit, Embase and Scopus to September 2017 and supplemented this with grey literature searches and handsearching of the references of the eligible studies. We assessed study quality using the Critical Appraisals Skills Programme suite of tools, excluding those judged to be of poor methodological quality. RESULTS:Two studies were included; both were cohort studies from the payer perspective of people leaving long-stay National Health Service hospitals in the UK between 1984 and 1992. One study found that deinstitutionalisation reduced costs, one study found an increase in costs. CONCLUSION:A wide-ranging literature review found limited evidence on costs associated with deinstitutionalisation for people with intellectual disabilities. From two studies included in the review, the results were conflicting. Significant gaps in the evidence base were observable, particularly with respect to priority populations in contemporary policy: older people with intellectual disabilities and serious medical illness, and younger people with very complex needs and challenging behaviours. PROSPERO REGISTRATION NUMBER:CRD42018077406.

SUBMITTER: May P

PROVIDER: S-EPMC6756329 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Effect of deinstitutionalisation for adults with intellectual disabilities on costs: a systematic review.

May Peter P Lombard Vance Richard R Murphy Esther E O'Donovan Mary-Ann MA Webb Naoise N Sheaf Greg G McCallion Philip P Stancliffe Roger R Normand Charles C Smith Valerie V McCarron Mary M

BMJ open 20190920 9

<h4>Objective</h4>To review systematically the evidence on the costs and cost-effectiveness of deinstitutionalisation for adults with intellectual disabilities.<h4>Design</h4>Systematic review.<h4>Population</h4>Adults (aged 18 years and over) with intellectual disabilities.<h4>Intervention</h4>Deinstitutionalisation, that is, the move from institutional to community settings.<h4>Primary and secondary outcome measures</h4>Studies were eligible if evaluating within any cost-consequence framework ...[more]

PMID: 31542732

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Project description:ObjectiveMental health problems are more prevalent in people with than without intellectual disabilities, yet treatment options have received little attention. The aim of this study was to identify and evaluate the effectiveness of pharmacological and psychological interventions in the treatment of mental health problems in children and adults with severe and profound intellectual disabilities, given their difficulties in accessing standard mental health interventions, particularly talking therapies, and difficulties reporting drug side effects.DesignA systematic review using electronic searches of PsycINFO, PsycTESTS, EMBASE, MEDLINE, CINAHL, ERIC, ASSIA, Science Citation Index, Social Science Citation Index and CENTRAL was conducted to identify eligible intervention studies. Study selection, data extraction and quality appraisal were performed by two independent reviewers.ParticipantsStudy samples included at least 70% children and/or adults with severe or profound intellectual disabilities or reported the outcomes of this subpopulation separate from participants with other levels of intellectual disabilities.InterventionsEligible intervention studies evaluated a psychological or pharmacological intervention using a control condition or pre-post design.OutcomesSymptom severity, frequency or other quantitative dimension (e.g., impact), as assessed with standardised measures of mental health problems.ResultsWe retrieved 41 232 records, reviewed 573 full-text articles and identified five studies eligible for inclusion: three studies evaluating pharmacological interventions, and two studies evaluating psychological interventions. Study designs ranged from double-blind placebo controlled crossover trials to single-case experimental reversal designs. Quality appraisals of this very limited literature base revealed good experimental control, poor reporting standards and a lack of follow-up data.ConclusionsMental ill health requires vigorous treatment, yet the current evidence base is too limited to identify with precision effective treatments specifically for children or adults with severe and profound intellectual disabilities. Clinicians therefore must work on the basis of general population evidence, while researchers work to generate more precise evidence for people with severe and profound intellectual disabilities.Prospero registration numberCRD 42015024469.

Dataset Information

Effect of deinstitutionalisation for adults with intellectual disabilities on costs: a systematic review.

Publications

Effect of deinstitutionalisation for adults with intellectual disabilities on costs: a systematic review.

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