Hospital at home or acute hospital care? A cost minimisation analysis

BMJ 1998;316:1802-1806 ( 13 June )

General Practice

Hospital at home or acute hospital care? A cost minimisation analysis

Editorial by IliffeGeneral practice pp 1786, 1791, 1796

Joanna Coast, lecturer in health economics, ^a Suzanne H Richards, research associate, ^a Tim J Peters, reader in medical statistics, ^a David J Gunnell, senior lecturer in epidemiology and public health medicine, ^a Mary-Anne Darlow, hospital at home team co-ordinator, ^b John Pounsford, consultant physician, care of the elderly. ^c

^a Department of Social Medicine, University of Bristol, Bristol BS8 2PR, ^b Hospital-at-Home, Downend Clinic, Bristol BS16 5TW, ^c Day Hospital, Frenchay Hospital, Bristol BS16 1LE

Correspondence to: Joanna Coast jo.coast{at}bristol.ac.uk

Objective: To compare, from the viewpoints of the NHS and social services and of patients, the costs associated withearly discharge to a hospital at home scheme and those associatedwith continued care in an acute hospital.
Design: Cost minimisation analysis.
Setting: Acute hospital wards and the community in the north of Bristol (population about 224 000).
Subjects: 241 hospitalised but medically stable elderly patients who fulfilled the criteria for early discharge toa hospital at home scheme and who consented to participate.
Main outcome measures: Costs to the NHS, social services, and patients over the 3 months after randomisation.
Results: The mean cost for hospital at home patients over the 3 months was £2516, whereas that for hospital patientswas £3292. Under all the assumptions used in the sensitivity analysis,the cost of hospital at home care was less than that of hospitalcare. Only when hospital costs were assumed to be less than 50%of those used in the initial analysis was the difference equivocal.
Conclusions: The hospital at home scheme is less costly than care in the acute hospital. These results may be generalisableto schemes of similar size and scope, operating in a similar contextof rising acute admissions.

Key messages

Some economic evaluations have found that hospital at home care is more costly than acute hospital care in the United Kingdom, and others have found that it is less costly
Cost minimisation analysis found a mean cost to the NHS and social services of £2516 per hospital at home patient and £3292 per hospital patient
For every £10 000 spent, routine hospital care could be provided for three patients, while early discharge to care in the hospital at home scheme could be provided for four patients
Sensitivity analysis (making differing assumptions for the cost of both services within reasonable boundaries) does not change the result that hospital at home is less costly than hospital care; only when hospital costs are assumed to be less than 50% of the original estimate does the difference become equivocal
Costs to patients were similar in the two arms of the trial

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