title: Cost effectiveness of pilot self-assessment sites in community care services in England.
abstract: OBJECTIVE
  Self-assessment has been advocated in community care but little is known of its cost effectiveness in practice. We evaluated cost effectiveness of pilot self-assessment approaches.
  
  
  METHODS
  Data were collected from 13 pilot projects in England, selected by central government, between October 2006 and November 2007. These were located within preventative services for people with low-level needs, occupational therapy, or assessment and care management. Cost effectiveness, over usual care, was assessed by incremental cost-effectiveness ratios (ICERs), in British pounds per unit gain in assessment satisfaction. A public-sector perspective was adopted; the provider costs of the agencies taking part.
  
  
  RESULTS
  At 2006-07 prices, including start-up and on-going costs, only three pilots demonstrated cost effectiveness. Two pilots in assessment and care management had ICERs of £3810 and £755 per satisfaction gained, well below a benchmark from a trial of usual assessment of £18296 per satisfaction gained. When extrapolating uptake to numbers accessing assessments over 1 year, one occupational therapy pilot, of £123/satisfaction gained, also fell below this benchmark in sensitivity analysis. There was less evidence for preventative services.
  
  
  CONCLUSIONS
  Most pilot projects were not cost effective. However, self assessment is potentially cost effective in assessment and care management and occupational therapy services. Better quality cost data from pilot sites would have permitted more detailed analysis. Measuring downstream effects in terms of users' well being from receipt of self-assessment would also be beneficial.
authors.affiliation: Personal Social Services Research Unit (PSSRU), University of Manchester, Faculty of Medical and Human Sciences, Dover Street Building, Oxford Road, Manchester M13 9PL, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Clarkson
authors.forename: Christian
authors.initials: C
authors.lastname: Brand
authors.forename: Jane
authors.initials: J
authors.lastname: Hughes
authors.forename: David
authors.initials: D
authors.lastname: Challis
authors.forename: Sue
authors.initials: S
authors.lastname: Tucker
authors.forename: Michele
authors.initials: M
authors.lastname: Abendstern
mesh_terms: D003153:Community Health Services / Q000191:economics*; D003362:Cost-Benefit Analysis; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D010865:Pilot Projects; D012647:Self-Assessment