Skip to main content


Log in

Can chronic disease be managed through integrated care cost-effectively? Evidence from a systematic review

  • Original Article
  • Published:
Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript



The increase in demand for integrated care models to manage chronic disease is a challenge for the Irish health system, which is traditionally organised around the acute hospital services. Implementing integrated care programmes requires significant investment, and thus, their economic impact requires consideration.


This paper updates the previous evidence on the cost-effectiveness of integrated care programmes to support the development of a cost-effective integrated care programme for chronic disease management.


A systematic review of economic evaluations of integrated care programmes for chronic diseases (respiratory, cardiovascular, diabetes and musculoskeletal diseases) was performed using methods guided by the principles of conducting systematic reviews. The evidence was combined and summarised using a narrative synthesis. A meta-analysis of the evidence was not performed due to the heterogeneity of interventions and associated outcomes.


Six studies met the inclusion criteria; no study considered an integrated model of care that dealt with more than one chronic illness. Four chronic conditions were examined: stroke, diabetes, cardiovascular disease and COPD. Three studies were full economic evaluations, and three were partial economic evaluations.


The economic evidence, examined within this review, suggests that integrated care programmes have the potential to be cost-effective, achieving greater health benefits and are less expensive than usual care. Across all the interventions considered, the reduction in inpatient and outpatient admissions was the main contributor to reducing costs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Kuipers Cavaco Y, Quoidbach V (2014) Public health in the EU: state-of-play and key policy challenges. Policy department A: economic and scientific policy. European Parliament, Brussels

  2. Jennings S (2014) Preventing chronic disease: defining the problem. Report from the prevention of chronic disease Programme. Health Service Executive, Dublin

    Google Scholar 

  3. HSE (2016) Health service annual report and financial statements 2015. Health Service Executive, Dublin

    Google Scholar 

  4. Nolte E, Pitchforth E (2014) What is the evidence on the economic impacts of integrated care. WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies, Copenhagen, Denmark

  5. Porter ME (2010) What is value in health care? N Engl J Med 363(26):2477–2481

    Article  CAS  PubMed  Google Scholar 

  6. DoH (2012) Future health: a strategic framework for reform of the health service 2012–2015. Dublin, Ireland

  7. Sampalli T (2012) Proposed model of integrated care to improve health outcomes for individuals with multimorbidities. Patient Prefer Adherence 6:757–764

    Article  PubMed  PubMed Central  Google Scholar 

  8. Nolte E, Knai C, Saltman RB (2014) Assessing chronic disease management in European health systems. WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies, Copenhagen, Denmark

  9. Tsiachristas A (2015) Payment and economic evaluation of integrated care. International Journal of Integrated Care 15 (2)

  10. CRD (2009) Systematic reviews: CRD’s guidance for undertaking reviews in health care. Centre for Reviews and Dissemination, University of York, UK

    Google Scholar 

  11. Evers S, Paulus A (2015) Health economics and integrated care: a growing and challenging relationship. International Journal of Integrated Care 15 (2)

  12. Nolte E, Knai C, McKee M (2008) Managing chronic conditions: experience in eight countries. WHO Regional Office Europe on behalf of the European Observatory on Health Systems and Policies, Copenhagen, Denmark

  13. Nolte E, McKee M (2008) Caring for people with chronic conditions: a health system perspective. McGraw-Hill Education, UK

  14. Kodner DL, Spreeuwenberg C (2002) Integrated care: meaning, logic, applications, and implications—a discussion paper. International Journal of Integrated Care 2 (4)

  15. HIQA (2014) Guidelines for the economic evaluation of health technologies in Ireland. Health Information and Quality Authority, Dublin, Ireland

  16. Shemilt I, Mugford M, Byford S, Drummond M, Eisenstein E, Knapp M, Mallender J, McDaid D, Vale L, Walker D (2008) Incorporating economics evidence. Cochrane Handbook for Systematic Reviews of Interventions:449–480

  17. Davies KS (2011) Formulating the evidence based practice question: a review of the frameworks. Evidence Based Library and Information Practice 6(2):75–80

    Article  Google Scholar 

  18. Van Exel N, Koopmanschap M, Scholte op Reimer WS, Niessen LW, Huijsman R (2005) Cost-effectiveness of integrated stroke services. QJM 98(6):415–425

    Article  CAS  PubMed  Google Scholar 

  19. Baeten SA, van Exel NJA, Dirks M, Koopmanschap MA, Dippel DW, Niessen LW (2010) Lifetime health effects and medical costs of integrated stroke services-a non-randomized controlled cluster-trial based life table approach. Cost Effectiveness and Resource Allocation 8(1)

  20. McRae IS, Butler JR, Sibthorpe BM, Ruscoe W, Snow J, Rubiano D, Gardner KL (2008) A cost effectiveness study of integrated care in health services delivery: a diabetes program in Australia. BMC Health Serv Res 8(1)

  21. Giorda C, Picariello R, Nada E, Tartaglino B, Marafetti L, Costa G, Petrelli A, Gnavi R (2014) Comparison of direct costs of type 2 diabetes care: different care models with different outcomes. Nutr Metab Cardiovasc Dis 24(7):717–724

    Article  CAS  PubMed  Google Scholar 

  22. Delate T, Olson KL, Rasmussen J, Hutka K, Sandhoff B, Hornak R, Merenich J (2010) Reduced health care expenditures after enrollment in a collaborative cardiac care service. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy 30(11):1127–1135

    Article  Google Scholar 

  23. Roberts JA, Maslin TK, Bakerly ND (2010) Development of an integrated chronic obstructive pulmonary disease service model in an inner-city region in the UK: initial findings and 12-month results. Primary Care Respiratory Journal 19(4):390–397

    Article  PubMed  Google Scholar 

  24. Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, Augustovski F, Briggs AH, Mauskopf J, Loder E (2013) Consolidated health economic evaluation reporting standards (CHEERS) statement. Cost Effectiveness and Resource Allocation 11 (1)

  25. Philips Z, Ginnelly L, Sculpher M, Claxton K, Golder S, Riemsma R, Woolacott N, Glanville J (2004) Review of guidelines for good practice in decision-analytic modelling in health technology assessment. Health Technology Assessment 8 (36)

  26. Huijsman R, Klazinga N, Scholteop Reimer W, Van Wijngaarden J, Van Exel N, Van Putte-Boon C, Prestholt F, Koopmanschap M, Niessen L (2001) Results of the EDISSE study of three regional experiments with stroke services. ZonMw—The Netherlands Organisation for Health Research and Development

  27. Bollen MD (1996) Recent changes in Australian general practice. Med J Aust 164(4):212

    CAS  PubMed  Google Scholar 

  28. UKDPS (1998) Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352(9131):837–853

    Article  Google Scholar 

  29. Wagner EH (1997) Chronic disease management: what will it take to improve care for chronic illness? Effective Clinical Practice 1(1):2–4

    Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to J. Cronin.

Electronic supplementary material


(DOCX 18 kb)


(DOCX 29 kb)


(DOCX 19 kb)


(DOCX 16 kb)


(DOCX 15 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cronin, J., Murphy, A. & Savage, E. Can chronic disease be managed through integrated care cost-effectively? Evidence from a systematic review. Ir J Med Sci 186, 827–834 (2017).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: