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BMC Public Health
Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Intellectual Disability | Research article

Access to health care for older people with intellectual disability: a modelling study to explore the cost-effectiveness of health checks

Authors: Annette Bauer, Laurence Taggart, Jill Rasmussen, Chris Hatton, Lesley Owen, Martin Knapp

Published in: BMC Public Health | Issue 1/2019

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Abstract

Background

Whilst people with intellectual disability grow older, evidence has emerged internationally about the largely unmet health needs of this specific ageing population. Health checks have been implemented in some countries to address those health inequalities. Evaluations have focused on measuring process outcomes due to challenges measuring quality of life outcomes. In addition, the cost-effectiveness is currently unknown. As part of a national guideline for this population we sought to explore the likely cost-effectiveness of annual health checks in England.

Methods

Decision-analytical Markov modelling was used to estimate the cost-effectiveness of a strategy, in which health checks were provided for older people with intellectual disability, when compared with standard care. The approach we took was explorative. Individual models were developed for a selected range of health conditions, which had an expected high economic impact and for which sufficient evidence was available for the modelling. In each of the models, hypothetical cohorts were followed from 40 yrs. of age until death. The outcome measure was cost per quality-adjusted life-year (QALY) gained. Incremental cost-effectiveness ratios (ICER) were calculated. Costs were assessed from a health provider perspective and expressed in 2016 GBP. Costs and QALYs were discounted at 3.5%. We carried out probabilistic sensitivity analysis. Data from published studies as well as expert opinion informed parameters.

Results

Health checks led to a mean QALY gain of 0.074 (95% CI 0.072 to 0.119); and mean incremental costs of £4787 (CI 95% 4773 to 5017). For a threshold of £30,000 per QALY, health checks were not cost-effective (mean ICER £85,632; 95% CI 82,762 to 131,944). Costs of intervention needed to reduce from £258 to under £100 per year in order for health checks to be cost-effective.

Conclusion

Whilst findings need to be considered with caution as the model was exploratory in that it was based on assumptions to overcome evidence gaps, they suggest that the way health systems deliver care for vulnerable populations might need to be re-examined. The work was carried out as part of a national guideline and informed recommendations about system changes to achieve more equal health care provisions.
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Literature
1.
Emerson E, Baines S, Allerton L, Welch V. Health inequalities & people with learning disabilities in the UK, improving health and lives: learning disabilities observatory; 2012.
2.
Evenhuis H, Henderson CM, Beange H, et al. Healthy ageing - adults with intellectual disabilities: physical health issues. Geneva, Switzerland: World Health Organization; 2000.
3.
Haveman M, Heller T, Lee L. Etal. Major health risks in aging persons with intellectual disabilities: an overview of recent studies. Journal of Policy and Practice in Intellectual Disabilities. 2010;7:59–69.CrossRef
4.
5.
Ali A, Scior K, Ratti V, Strydom A, King M, Hassioitis A. Discrimination and other barriers to accessing health care: perspectives of patients with mild and moderate intellectual disability and their carers. PLoS One. 2013;8:e70855.PubMedPubMedCentralCrossRef
6.
Bigby C. Ageing with a lifelong disabilities: a guide to practice, program and policy issues for human services professionals. London: Jessica Kingsley Publishers; 2004.
7.
McCarron M, Swinburne J, Burke E, McGlinchey E, Carroll R, McCallion P. Patterns of multimorbidity in an older population of persons with an intellectual disability: results from the intellectual disability supplement to the Irish longitudinal study on aging (IDS-TILDA). Res Development Disabilit. 2013;34:521–7.CrossRef
8.
Hermans H, Evenhuis HM. Multimorbidity in older adults with intellectual disabilities. Res Development Disabilit. 2014;35:776–83.CrossRef
9.
McCarron M, Lawlor BA. Responding to the challenges of ageing and dementia in intellectual disability in Ireland. Aging Ment Health. 2003;7:413–7.PubMedCrossRef
10.
11.
Ouellette-Kuntz H, Garcin N, Lewis S, Minnes P, Freeman C, Holden J. Addressing health disparities through promoting equity for individuals with intellectual disabilities. Can J Public Health. 2005;96(2):S8–S22.PubMed
12.
13.
Srikanth R, Cassidy G, Joiner C, Teeluckdharry S. Osteoporosis in people with intellectual disabilities: a review and a brief study of risk factors for osteoporosis in a community sample of people with intellectual disabilities. J Intellect Disabil Res. 2011;55(1):53–62.PubMedCrossRef
14.
Bent S, McShea L, Brennan S. The importance of hearing: a review of the literature on hearing loss for older people with learning disabilities. Br J Learn Disabil. 2015;43(4):277–84.CrossRef
15.
Bowers B, Webber R, Bigby C. Health issues of older people with intellectual disabilities in group homes. J Intellect Develop Disabil. 2014;39(3):261–9.CrossRef
16.
Cooper SA, Morrison J, Allan LM, et al. Practice nurse health checks for adults with intellectual disabilities: a cluster-design, randomised controlled trial. Lancet Psychiatry. 2014;1:511–21.PubMedCrossRef
17.
McCarron M, Buke E, Clearly E, Carroll R, McGlincey E, McCallion P. Changes in physical and Behavioural health of with an intellectual disabilities ageing. In: Burke E, McCallion P, McCarron M, editors. Advancing years, different challenges: wave 2 IDS-TILDA, findings on the ageing of people with and intellectual disabilities. Dublin: School of Nursing and Midwifery, the University of Dublin, Trinity College; 2014.
18.
O'Leary L, Cooper SA, Hughes-McCormack L. Early death and causes of death of people with intellectual disabilities: a systematic review. J Appl Res Intellect Disabil. 2018;31(3):325–42.PubMedCrossRef
19.
Heslop P, Blair PS, Fleming P, Hoghton M, Marriott A, Russ L. The confidential inquiry into premature deaths of people with intellectual disabilities in the UK: a population-based study. Lancet. 2013;383:889–95.PubMedCrossRef
20.
Glover G, Williams R, Heslop P, Oyinlola J, Grey J. Mortality in people with intellectual disabilities in England. J Intellect Disabil Res. 2017;61(1):62–74.PubMedCrossRef
21.
Robertson J, Hatton C, Emerson E, Baines S. The impact of health checks for people with intellectual disabilities: an updated systematic review. Res Dev Disabil. 2014;35:2450–62.PubMedCrossRef
22.
McConkey T, Taggart L, Kane M. Optimising the uptake of health checks for people with intellectual disabilities. J Intellect Disabil. 2015;19(3):205–14.PubMedCrossRef
23.
Buszewicz M, Welch C, Horsfall L, et al. Assessment of an incentivised scheme to provide annual health checks in primary care for adults with intellectual disabilities: a longitudinal cohort study. Lancet Psychiatry. 2014;1:522–30.PubMedCrossRef
24.
25.
26.
27.
28.
Carvill S. Sensory impairments, intellectual disabilities and psychiatry. J Intellect Disabil Res. 2001;45(6):467–83.PubMedCrossRef
29.
Kerr AM, McCulloch D, Oliver K, et al. Medical needs of people with intellectual disabilities require regular reassessment, and the provision of client- and carer-held reports. J Intellect Disabil Res. 2003;47(2):134–45.PubMedCrossRef
30.
31.
32.
33.
Tancredi M, Rosengren A, Svensson AM, et al. Excess mortality among persons with type 2 diabetes. N Engl J Med. 2015;373(18):1720–32.PubMedCrossRef
34.
Lee S, Shafe AC, Cowie MR. UK stroke incidence, mortality and cardiovascular risk management 1999–2008: time-trend analysis from the general practice Research database. BMJ Open. 2011;1(2):e000269.PubMedPubMedCentral
35.
Sculpher M. The use of probabilistic sensitivity analysis for decision making: the example of drug-eluting stents. Presentation, seminar at Havard Clinical Research Institute. 2004;(17 August 2004).
36.
37.
Lovibond K, Jowett S, Barton P, et al. Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study. Lancet. 2011;378:1219–30.PubMedCrossRef
38.
Clarke PM, Gray AM, Briggs A, et al. Cost-utility analyses of intensive blood glucose and tight blood pressure control in type 2 diabetes (UKPDS 72). Diabetologia. 2005;48:868–77.PubMedCrossRef
39.
Tappenden P, Chilcott J, Eggington S, et al. Option appraisal of population-based colorectal cancer screening programmes in England. Gut. 2007;56(5):677–84.PubMedCrossRef
40.
41.
Laudicella M, Walsh B, Burns E, Smith PC. Cost of care for cancer patients in England: evidence from population-based patient-level data. Br J Cancer. 2016;114(11):1286–92.PubMedPubMedCentralCrossRef
42.
43.
44.
Leal J, Gray AM, Prieto-Alhambra D, et al. The REFReSH study group, impact of hip fracture on hospital care costs: a population-based study. Osteoporos Int. 2016;27:549–58.PubMedCrossRef
45.
46.
Burr JM, Mowatt G, Hernández R, et al. The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation. Health Technol Assess. 2007;11(41).
47.
Frampton G, Harris P, Cooper K, et al. The clinical effectiveness and cost-effectiveness of second-eye cataract surgery: a systematic review and economic evaluation. Health Technol Assess. 2014;18:1–205 v–vi.PubMedPubMedCentralCrossRef
48.
Clegg A, Loveman E, Gospodarevskaya E, et al. The safety and effectiveness of different methods of ear wax removal: a systematic review and economic evaluation. Health Technol Assess. 2010;14(28).
49.
50.
Lennox N, Bain C, Rey-Conde T, et al. Effects of a comprehensive health assessment programme for Australian adults with intellectual disabilities: a cluster randomized trial. Int J Epidemiol. 2007;36:139–46.PubMedCrossRef
51.
Lennox N, Ware R, Bain C, et al. Effects of health screening for adults with intellectual disabilities: a pooled analysis. Br J Gen Pract. 2011;61:193–6.PubMedPubMedCentralCrossRef
52.
Hewitson P, Ward AM, Heneghan C, et al. Primary care endorsement letter and a patient leaflet to improve participation in colorectal cancer screening: results of a factorial randomised trial. Br J Cancer. 2011;105:475–80.PubMedPubMedCentralCrossRef
53.
Gardner MP, Adams A, Jeffreys M. Interventions to increase the uptake of mammography amongst low income women: a systematic review and meta-analysis. PLoS One. 2013;8:e55574.PubMedPubMedCentralCrossRef
54.
Moran AE, Odden MC, Thanataveerat A, et al. Cost-effectiveness of hypertension therapy according to 2014 guidelines. N Engl J Med. 2015;372(5):447–55.PubMedPubMedCentralCrossRef
55.
Straus SE, Majumdar SR, McAlister FA. New evidence for stroke prevention: scientific review. Jama. 2002;288(11):1388–95.PubMedCrossRef
56.
Padwal R, Straus SE, McAlister FA. Cardiovascular risk factors and their effects on the decision to treat hypertension: evidence based review. BMJ. 2001;322:977–80.PubMedPubMedCentralCrossRef
57.
Scholefield JH, Moss S, Sufi F, Mangham CM, Hardcastle JD. Effect of faecal occult blood screening on mortality from colorectal cancer: results from a randomised controlled trial. Gut. 2002;50:840–4.PubMedPubMedCentralCrossRef
58.
Raine R, Duffy SW, Wardle J, et al. Impact of general practice endorsement on the social gradient in uptake in bowel cancer screening. Br J Cancer. 2016;114:321–6.PubMedPubMedCentralCrossRef
59.
Logan RF, Patnick J, Nickerson C, et al. Outcomes of the bowel Cancer screening Programme (BCSP) in England after the first 1 million tests. Gut. 2011;61(10):1439–46.PubMedPubMedCentralCrossRef
60.
Shepstone L. The SCOOP study – do we now have a rationale to screen for osteoporosis? National Osteoporosis Conference, 7 November 2016, Norwich CTU: University of East Anglia; 2016.
61.
Okeke CO, Quigley HA, Jampel HD, et al. Adherence with topical glaucoma medication monitored electronically the Travatan dosing aid study. Ophthalmology. 2009;116:191–9.PubMedCrossRef
62.
Morris AE, Lutman ME, Cook AJ, Turner D. An economic evaluation of screening 60- to 70-year-old adults for hearing loss. J Public Health (Oxf). 35(1):139–46.PubMedCrossRef
63.
Sinclair N, Littenberg B, Geller B, Muss H. Accuracy of screening mammography in older women. AJR Am J Roentgenol. 2011;197(5):1268–73.PubMedCrossRef
64.
Dyer MT, Goldsmith KA, Sharples LS, Buxton MJ. A review of health utilities using the EQ-5D in studies of cardiovascular disease. Health Qual Life Outcomes. 2010;8:13.PubMedPubMedCentralCrossRef
65.
Whyte S, Chilcott J, Halloran S. Reappraisal of the options for colorectal cancer screening in England. Color Dis. 2012;14:e547–61.CrossRef
66.
Tappenden P, Chilcott J, Eggington S, et al. Option appraisal of population-based colorectal cancer screening programmes in England. Gut. 2007;56:677–84.PubMedCrossRef
67.
Briggs A, Sculpher M, Claxton K. Chapter 4: making decision models probabilistic. In: decision modelling for health economic evaluation. Oxford: Oxford University Press; 2006. p. 77–120.
68.
Russell AM, O’Dwyer JL, Bryant LD, House AO, Birtwistle JC, Meer S, et al. The feasibility of using the EQ-5D-3L with adults with mild to moderate learning disabilities within a randomized control trial: a qualitative evaluation. Pilot Feasibility Stud. 2018;4(1):164.PubMedPubMedCentralCrossRef
69.
Riemsma RP, Forbes CA, Glanville JM, Eastwood AJ, Kleijnen J. General health status measures for people with cognitive impairment: learning disability and acquired brain injury. Health Technol Assess. 2001;5.
70.
Williams V, Battleday S. Where do you want to go next? Bristol: Norah Fry Research Centre, University of Bristol; 2007.
71.
Romeo R, Knapp M, Morrison J, et al. Cost estimation of a health-check intervention for adults with intellectual disabilities in the UK. J Intellect Disabil Res. 2009;53:426–39.PubMedCrossRef
72.
Carey IM, Hosking FJ, Harris T, et al. Do health checks for adults with intellectual disabilities reduce emergency hospital admissions? Evaluation of a natural experiment. J Epidemiol Community Health. 2017;71:52–8.PubMedCrossRef
73.
Strydom A, Romeo R, Perez-Achiaga N, et al. Service use and cost of mental disorder in older adults with intellectual disabilities. Br J Psychiatry. 2010;196:133–8.PubMedCrossRef
74.
Heslop P, Read S, Dunwoodie Stirton F. The hospital provision of reasonable adjustments for people with learning disabilities: findings from freedom of information requests. Br J Learn Disabil. 2018;46(4):258–67.CrossRef
75.
Tuffrey-Wijne I, Goulding L, Giatras N, Abraham E, Gillard S, White S, et al. The barriers to and enablers of providing reasonably adjusted health services to people with intellectual disabilities in acute hospitals: evidence from a mixed-methods study. BMJ Open. 2014;4(4):e004606.PubMedPubMedCentralCrossRef
76.
77.
Alborz A, McNally R, Glendinning C. Access to health care for people with learning disabilities in the UK: mapping the issues and reviewing the evidence. J Health Serv Res Policy. 2005;10:173–82.PubMedPubMedCentralCrossRef
78.
Osborn DPJ, Horsfall L, Hassiotis A, et al. Access to cancer screening in people with learning disabilities in the UK: cohort study in the health improvement network, a primary care research database. PLoS One. 2012;7:e43841.PubMedPubMedCentralCrossRef
79.
Heller T, Sorenson A. Promoting healthy ageing in adults with developmental disabilities. Dev Disabil Res Rev. 2013;18:22–30.PubMedCrossRef
80.
Davies N, Duff M. Breast screening for older women with intellectual disabilities living in community group homes. J Intellect Disabil Res. 2001;45:253–7.PubMedCrossRef
81.
McIifatrick S, Taggart L, Truesdale-Kennedy M. Supporting women with intellectual disabilities to access breast cancer screening: a healthcare professional perspective. Eur J Cancer Care. 2011;20:412–20.CrossRef
82.
Wilkinson JE, Lauer E, Freud KM, Rosen AK. Determinants of mammography in women with intellectual disabilities. J Am Board Fam Med. 2011;24(6):693–703.PubMedPubMedCentralCrossRef
83.
Goodyear-Smith F. Government's plans for universal health checks for people aged 40-75: no certainty that they'll do more good than harm. BMJ. 2013;347:5–5.CrossRef
84.
85.
86.
87.
Strydom A, Hassiotis A, Livingston G. Mental health and social care needs of older people with intellectual disabilities. J Appl Res Intellect Disabil. 2005;18:229–35.CrossRef
Metadata
Title
Access to health care for older people with intellectual disability: a modelling study to explore the cost-effectiveness of health checks
Authors
Annette Bauer
Laurence Taggart
Jill Rasmussen
Chris Hatton
Lesley Owen
Martin Knapp
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-6912-0

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