The UK fares worse than other high-income countries in the clinical management and health outcomes of children with chronic conditions such as asthma, eczema and constipation. Strengthening the integration of health services across primary (GP practices) and secondary (hospital) care has been recommended in previous research to improve care for this population. However, little is known about the value for money (or cost-effectiveness) of this approach, which is particularly urgent in the current global context of constrained health budgets. Our paper is important because it provides the first robust evidence on the cost-effectiveness of integrated care for children with chronic conditions.
Dr Marina Soley-Bori
14 May 2024
Integrated care for children with chronic conditions improves care quality and may be cost-effective in the long term
The analysis of the Children and Young People's Health Partnership (CYPHP) model in South London has shown the potential for a positive impact on cost effectiveness and quality of care
Researchers at King’s have found that integrated care across primary and secondary care for children with chronic conditions (asthma, eczema, or constipation) shows promising long-term results once impacts on not only the National Health Service (NHS) and Personal Social Services (PSS) are considered, but also children, families and schools.
Paediatric health systems across high-income countries are facing avoidable adverse outcomes alongside increasing demands and costs. To relieve this, integrated care is seen as a major policy priority across high-income countries. The study by Marina Soley-Bori and colleagues is an important step towards evidence on the cost effectiveness of integrated care.
Published in The Lancet Regional Health, this study looked to measure the cost-effectiveness of the CYPHP model of integrated care, based on data from the CYPHP trial, the largest randomised controlled trial of children’s integrated care globally. The study used a range of economic evaluation methods, including cost-effectiveness, cost-utility, and cost-benefit analyses, to assess the CYPHP model at key horizon points of 6 months and 12 months. Impacts on the NHS/ PSS and also children, families and schools were accounted for.
CYPHP is a complex health system strengthening programme that provides local child health clinics jointly run by GPs and paediatricians, targeted and proactive case finding with biopsychosocial care for children with chronic conditions, and training resources for professionals working with children and young people.
The Children and Young People’s Health Partnership trial was led by Professor Ingrid Wolfe between 2019 to 2021 and involved 23 general practice clusters across a population of 97,970 children in South London. The trial allowed researchers to monitor and measure the impact of the CYPHP model against a control group following an enhanced usual care model.
Researchers analysed the results of the trial, comparing the changes in health care costs to changes in health outcomes of participants and controls. It was found that that in the shorter term (within 6 months) and from the perspective of the NHS/PSS, the health gains yielded by CYPHP were not large enough to compensate for its costs. However, CYPHP shows signs of being cost-effective in the longer term (12 months) and when impacts on patients, families and schools are considered.
These findings suggest that CYPHP may have a longer-term, rather than immediate, effect on health outcomes and costs beyond 12 months. The observed delay in the embedment of CYPHP into real clinical practice may also explain these results and justify future evaluation through further large-scale research into health services and systems.
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Lecturer in Health Economics