Cost effectiveness of pilot self-assessment sites in community care services in England

Abstract

Objective Self-assessment has been advocated in community care but little is known of its cost effectiveness in practice. We evaluated cost effectiveness of pilot self-assessment approaches. Methods Data were collected from 13 pilot projects in England, selected by central government, between October 2006 and November 2007. These were located within preventative services for people with low-level needs, occupational therapy, or assessment and care management. Cost effectiveness, over usual care, was assessed by incremental cost-effectiveness ratios (ICERs), in British pounds per unit gain in assessment satisfaction. A public-sector perspective was adopted; the provider costs of the agencies taking part. Results At 2006–07 prices, including start-up and on-going costs, only three pilots demonstrated cost effectiveness. Two pilots in assessment and care management had ICERs of £3810 and £755 per satisfaction gained, well below a benchmark from a trial of usual assessment of £18296 per satisfaction gained. When extrapolating uptake to numbers accessing assessments over 1 year, one occupational therapy pilot, of £123/satisfaction gained, also fell below this benchmark in sensitivity analysis. There was less evidence for preventative services. Conclusions and implications Most pilot projects were not cost effective. However, self assessment is potentially cost effective in assessment and care management and occupational therapy services. Better quality cost data from pilot sites would have permitted more detailed analysis. Measuring downstream effects in terms of users’ well being from receipt of self-assessment would also be beneficial. What is known about this topic? A consumer case for self assessment in community social care has been advanced and policy in England has advocated the approach. The cost effectiveness of such approaches is not known. What does this paper add? This paper suggests that implementing a self-assessment approach in assessment and care management and occupational therapy services is potentially cost effective taking account of a range of assumptions concerning uptake. What are the implications for practitioners? For policy makers, these data suggest self assessment could provide enhanced user satisfaction with the assessment process at a relatively modest investment. For agencies implementing the approach, better quality data systems are needed that can track costs and impacts to evaluate the approach further.