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

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 pound f2569 (pound 1655), hospital ward pound 2881 (pound 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 pound 2557 (pound 1710), hospital ward pound 3660 (pound 2903), bootstrap mean difference - 1071 (-1843 to -246). At thee months the cost differences were sustained. Costs with all cases included were hospital at home pound 3671 (pound 2491), hospital ward pound 3877 (pound 3405), bootstrap mean difference -210 (-1025 to 635). When only those accepting allocated care were included the costs were hospital at home pound 3698 (pound 2493), hospital ward pound 4761 (pound 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 pound 207 v pound 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.