BMJ 1999;319:1547-1550 ( 11 December )

General Practice

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

Jeremy Jones, lecturer in health economics, ^a Andrew Wilson, senior lecturer, ^b Hilda Parker, research fellow, ^b Alison Wynn, research associate, ^b Carol Jagger, senior lecturer, ^c Nicky Spiers, fellow in health services research, ^c Gillian Parker, professor. ^a

^a Nuffield Community Care Studies Unit, University of Leicester, Leicester LE1 6TP, ^b Department of General Practice and Primary Health Care, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, ^c Department of Epidemiology and Public Health, University of Leicester, Leicester LE1 6TP

Correspondence to: Andrew Wilson AW7{at}le.ac.uk

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 treathospital at home £2569 (£1655), hospital ward £2881 (£2031), 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 cheaperhospital at home £2557 (£1710), hospital ward £3660 (£2903), 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 (£2491), hospital ward £3877 (£3405), bootstrap mean difference 210 (1025 to 635). When only those accepting allocated care were included the costs were hospital at home £3698 (£2493), hospital ward £4761 (£3940), 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 v £134 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.

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