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

Objectives: To examine the cost of providing hospital at home in place of some for ms 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 sen ice, 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 fi-om 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.