Costs and Health Outcomes in Economic Evaluations of Person-Centered Care: A Systematic Review.

Objectives: The aim was to explore the current evidence on the costs and cost-effectiveness of person-centered care (PCC). This includes exploring how results vary by populations, settings, and PCC operationalization.

Methods: PubMed, Scopus, CINAHL, and gray literature were systematically searched using terms related to PCC and economic evaluations. Selection of studies, extraction of data, and assessment of potential bias using a published checklist were conducted by 2 independent reviewers. Articles were included if indicating PCC as a partnership between carer and patient and reporting costs. Synthesis without meta-analysis was performed using categories based on PCC being either (1) cost-effective, (2) cost saving with negative health outcomes, (3) more costly but effective, or (4) more costly and less effective than usual care, respectively. Classification also considered adherence to the Gothenburg model for PCC cornerstones.

Results: Of 2802 articles identified, 44 articles (representing 40 studies) met the specified inclusion criteria. Studies were from the period 1986 to 2021, mostly from high-income countries, and targeting patients above 60 years with long-term condition or multiple comorbidities. Most studies found PCC to be dominating usual care (n = 26), cost-effective (n = 1), or cost saving (n = 3). Only 4 studies found PCC to be dominated by usual care. Limiting the analysis to the cornerstones listed in the Gothenburg model gave similar but limited results.

Conclusions: Although most studies found PCC to be cost-effective or cost saving, these findings have limited applicability for system-wide decision making because of significant variations in study methodologies and patient populations.