Economic evaluation of hospital at home versus hospital care: cost minimisation analysis of data from randomised controlled trial.

OBJECTIVES

To compare the costs of admission to a hospital at home scheme with those of acute hospital admission.

DESIGN

Cost minimisation analysis within a pragmatic randomised controlled trial.

SETTING

Hospital at home scheme in Leicester and the city's three acute hospitals.

PARTICIPANTS

199 consecutive patients assessed as being suitable for admission to hospital at home for acute care during the 18 month trial period (median age 84 years).

INTERVENTION

Hospital at home or hospital inpatient care.

MAIN OUTCOME MEASURES

Costs to NHS, social services, patients, and families during the initial episode of treatment and the three months after admission.

RESULTS

Mean (median) costs per episode (including any transfer from hospital at home to hospital) were similar when analysed by intention to treat-hospital at home 2569 pounds sterling (1655 pounds sterling), hospital ward 2881 pounds sterling (2031 pounds sterling), bootstrap mean difference -305 (95% confidence interval -1112 to 448). When analysis was restricted to those who accepted their allocated place of care, hospital at home was significantly cheaper-hospital at home 2557 pounds sterling(1710 pounds sterling), hospital ward 3660 pounds sterling (2903 pounds sterling), bootstrap mean difference -1071 (-1843 to -246). At three months the cost differences were sustained. Costs with all cases included were hospital at home 3671 pounds sterling (2491 pounds sterling), hospital ward 3877 pounds sterling (3405 pounds sterling), bootstrap mean difference -210 (-1025 to 635). When only those accepting allocated care were included the costs were hospital at home 3698 pounds sterling (2493 pounds sterling), hospital ward 4761 pounds sterling (3940 pounds sterling), bootstrap mean difference -1063 (-2044 to -163); P=0.009. About 25% of the costs for episodes of hospital at home were incurred through transfer to hospital. Costs per day of care were higher in the hospital at home arm (mean 207 pounds sterling v 134 pounds sterling in the hospital arm, excluding refusers, P<0.001).

CONCLUSIONS

Hospital at home can deliver care at similar or lower cost than an equivalent admission to an acute hospital.