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

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7224.1547 (Published 11 December 1999) Cite this as: BMJ 1999;319:1547
  1. Jeremy Jones, lecturer in health economicsa,
  2. Andrew Wilson, senior lecturer (AW7{at}le.ac.uk)b,
  3. Hilda Parker, research fellowb,
  4. Alison Wynn, research associateb,
  5. Carol Jagger, senior lecturerb,
  6. Nicky Spiers, fellow in health services researchc,
  7. Gillian Parker, professora
  1. a Nuffield Community Care Studies Unit, University of Leicester, Leicester LE1 6TP
  2. b Department of General Practice and Primary Health Care, University of Leicester, Leicester General Hospital, Leicester LE5 4PW
  3. c Department of Epidemiology and Public Health, University of Leicester, Leicester LE1 6TP
  1. Correspondence to: Andrew Wilson
  • Accepted 15 November 1999

Abstract

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 (£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 cheaper—hospital 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.

Footnotes

  • Funding National R&D Programme, Primary-Secondary Care Interface, NHS Executive, North Thames.

  • Competing interests None declared.

  • Accepted 15 November 1999
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