Randomised controlled trial comparing hospital at home care with inpatient hospital care. II: cost minimisation analysis

Abstract

Objectives: To examine the cost of providing hospital at home in place of some forms of inpatient hospital care. Design: Cost minimisation study within a randomised controlled trial. Setting: District general hospital and catchment area of neighbouring community trust. Subjects: Patients recovering from hip replacement (n=86), knee replacement (n=86), and hysterectomy (n=238); elderly medical patients (n=96); and patients with chronic obstructive airways disease (n=32). Interventions: Hospital at home or inpatient hospital care. Main outcome measures: Cost of hospital at home scheme to health service, to general practitioners, and to patients and their families compared with hospital care. Results: No difference was detected in total healthcare costs between hospital at home and hospital care for patients recovering from a hip or knee replacement, or elderly medical patients. Hospital at home significantly increased healthcare costs for patients recovering from a hysterectomy (ratio of geometrical means 1.15, 95% confidence interval 1.04 to 1.29, P=0.009) and for those with chronic obstructive airways disease (Mann-Whitney U test, P=0.01). Hospital at home significantly increased general practitioners' costs for elderly medical patients (Mann-Whitney U test, P<0.01) and for those with chronic obstructive airways disease (P=0.02). Patient and carer expenditure made up a small proportion of total costs. Conclusion: Hospital at home care did not reduce total healthcare costs for the conditions studied in this trial, and costs were significantly increased for patients recovering from a hysterectomy and those with chronic obstructive airways disease. There was some evidence that costs were shifted to primary care for elderly medical patients and those with chronic obstructive airways disease. Key messages: Hospital at home schemes are a popular alternative to standard hospital care, but there is uncertainty about their cost effectiveness In our randomised controlled trial we compared the cost of hospital at home care with that of inpatient hospital care for patients recovering from hip replacement, knee replacement, and hysterectomy; elderly medical patients; and those with chronic obstructive airways disease There were no major differences in health service costs between the two arms of the trial for patients recovering from hip or knee replacement and elderly medical patients Hospital at home care increased healthcare costs for patients recovering from hysterectomy and for those with chronic obstructive airways disease Hospital at home care resulted in some costs shifting to general practitioners for elderly medical patients and those with chronic obstructive airways disease