Hunter Rachael Maree, Frost Rachael, Kalwarowsky Sarah, Marston Louise, Pan Shengning, Avgerinou Cristina, Clegg Andrew, Cooper Claudia, Drennan Vari M, Gardner Benjamin, Goodman Claire, Logan Pip, Skelton Dawn A, Walters Kate
Research Department of Primary Care and Population Health, University College London, London, UK.
Public and Allied Health, Liverpool John Moores University, Liverpool, UK.
Appl Health Econ Health Policy. 2025 Jul 9. doi: 10.1007/s40258-025-00987-4.
Health promotion initiatives are often promoted as being worth the investment given future cash-savings. This paper uses the findings of HomeHealth, a health promotion service for older adults with mild frailty, to examine how economic evaluation relates to local decision making in England.
The HomeHealth trial randomised 388 participants aged 65+ years with mild frailty to receive HomeHealth (195 participants) or treatment as usual (193 participants). Health and social care resource use and carer time were self-completed at baseline, 6 months and 12 months. Primary and secondary healthcare resource use and medications were collected from patient files at 12 months post recruitment, covering the past 18 months. Stakeholders including commissioners were consulted on the results of the trial and budget impact.
Participants allocated to HomeHealth had a significant reduction in emergency hospital admissions at 12 months (incident rate ratio (IRR) 0.65; 95% confidence interval (CI) 0.45-0.92) and unpaid carer hours at 6 months (- 16 h (95% CI - 18 to - 14 h) or - £360 (95% CI - 369 to - 351) per patient). Although the intervention is cost saving overall due to fewer emergency admissions, at a cost of £457 per patient commissioners do not have the budget to fund it.
This case study illustrates the problem with using standard economic evaluation methods to argue for implementation of health promotion initiatives in publicly financed healthcare systems. Although HomeHealth resulted in reduced emergency admissions and may be cost saving to the system as a whole, it is not locally cash releasing. Health promotion initiatives are unlikely to be funded from local budgets without significant system-wide changes.
鉴于未来的现金节省情况，健康促进举措通常被宣传为值得投资。本文利用针对轻度虚弱老年人的健康促进服务“居家健康”的研究结果，来探讨经济评估与英格兰地方决策之间的关系。
“居家健康”试验将388名65岁及以上的轻度虚弱参与者随机分为两组，一组接受“居家健康”服务（195名参与者），另一组接受常规治疗（193名参与者）。健康和社会护理资源使用情况以及护理人员时间在基线、6个月和12个月时通过自我填写完成。主要和二级医疗保健资源使用情况以及药物信息在招募后12个月从患者档案中收集，涵盖过去18个月。就试验结果和预算影响咨询了包括专员在内的利益相关者。
分配到“居家健康”组的参与者在12个月时急诊入院人数显著减少（发生率比（IRR）为0.65；95%置信区间（CI）为0.45 - 0.92），在6个月时无薪护理人员工作时长减少（每位患者减少 - 16小时（95% CI - 18至 - 14小时）或 - 360英镑（95% CI - 369至 - 351英镑））。尽管由于急诊入院人数减少，该干预措施总体上节省了成本，但每位患者成本为457英镑，专员们没有预算来资助它。
本案例研究说明了使用标准经济评估方法来主张在公共资助的医疗系统中实施健康促进举措存在的问题。尽管“居家健康”服务减少了急诊入院人数，并且可能对整个系统节省成本，但它在地方层面并不会带来现金盈余。如果没有全系统的重大变革，健康促进举措不太可能从地方预算中获得资金。
