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

    May, Peter and Lombard-Vance, Richard (2019) Effect of deinstitutionalisation for adults with intellectual disabilities on costs: a systematic review. BMJ Open, 9 (e02573). ISSN 2044-6055

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    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.

    Item Type: Article
    Additional Information: This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: Cite as: May P, Lombard Vance R, Murphy E, et al. Effect of deinstitutionalisation for adults with intellectual disabilities on costs: a systematic review. BMJ Open 2019;9:e025736. doi:10.1136/bmjopen-2018-025736
    Keywords: deinstitutionalisation; adults with intellectual disabilities; costs;
    Academic Unit: Faculty of Science and Engineering > Psychology
    Item ID: 15079
    Identification Number:
    Depositing User: Richard Lombard-Vance
    Date Deposited: 30 Nov 2021 16:34
    Journal or Publication Title: BMJ Open
    Publisher: BMJ Publishing Group
    Refereed: Yes
    Use Licence: This item is available under a Creative Commons Attribution Non Commercial Share Alike Licence (CC BY-NC-SA). Details of this licence are available here

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