OBJECTIVES: Long term care (LTC) such as Vision Reablement (VR) services are widely regarded as complex interventions. These have been implemented throughout England and involve professionals from multiple training backgrounds working together to support users to live at home independently. Their aim is to reduce users’ needs for health and social care services and to support their health and wellbeing. This work reviews the lessons learned from an economic evaluation of VR services, with suggestions about how to undertake future evaluations of such LTC services.

METHODS: The Improving Rehabilitation for people with Impaired Sight (IRIS) project used a prospective cohort design to explore the cost-effectiveness of models of VR services in England: in-house and contracted-out. A survey collected data on users’ characteristics, health-related quality of life (QoL) using EQ-5D 5L, social care-related QoL using the Adult Social Care Outcomes Toolkit, and resource use and costs across multiple public and non-public sectors. Analyses were undertaken from multiple perspectives for use by decision makers with different objectives. Different analytical approaches to missing data were implemented and regression analysis techniques were used to tackle potential selection bias.

RESULTS: Complete-case analysis results from a health and social care perspective suggested that users of in-house VR services have similar QALYs and costs compared to contracted-out users (difference in QALYs=0.002, p=0.891; difference in costs=-£36, p=0.971). In-house and contracted-out VR services were found to have equivalent probability of being cost-effective. Similar results were obtained under different perspectives and analytical approaches.

CONCLUSIONS: The cost-effectiveness of LTC VR services raises challenges in terms of optimising study design and minimising missing data to obtain relevant outcomes and costs. Future evaluations require further thought on how to enhance study design and data collection, as well as exploring the potential of innovative analytical methods in order to undertake well-controlled studies.