A systematic review of economic evaluations of community-based healthcare interventions for neurodisability management

Individuals with neurodisabilities require comprehensive support to improve outcomes in multiple areas related to their primary condition, such as continence, mobility, and psychological wellbeing. Insufficient management of neurodisabilities can negatively impact an individual’s quality of life, and the resulting economic burden can be significant. One way to ensure quality of care in an economically viable way is through community-based service provision, allowing individuals to seek healthcare locally. This systematic literature review identifies, collates, and summarises empirical evidence on economic evaluations and their corresponding methods used to investigate the economic impact of community-based healthcare interventions for neurodisability management. A systematic search of the literature was conducted across six databases, with study selection guided by a Population, Intervention, Comparison, Outcomes and Study (PICOS) framework. Studies published after January 1990 assessing minimally to non-invasive community-based interventions for continence, mobility and psychological wellbeing were considered. Of the 1,216 studies identified, 94 were selected for a full-text examination, of which 14 met the inclusion criteria. Full economic evaluations were performed in eight studies, while six were partial economic evaluations. Just five studies describe interventions explicitly delivered in the community; the remainder describe clinical-based interventions which could be implemented at the community level or interventions provided in both community and clinical settings. Most studies were performed from the narrower healthcare provider perspective, suggesting that costs may be underestimated. Studies that measured health-related quality of life outcomes used either generic preference-based measures alone or in combination with a non-preference-based or disease-specific measure. Overall, economic evidence regarding the use of community-based interventions for neurodisability management is scarce, reflecting both a limited number of such interventions and a lack of formal economic evaluations assessing them. Moreover, the methodology used to determine cost effectiveness is heterogenous. Choice of intervention, population, perspective, and time horizon was possibly restricted by the trial-based data available. Future studies could consider using decision analytical modelling to overcome some of these barriers.