The Bologna Hospital-at-Home: a model for cost-effective care of advanced cancer patients in developing countries

There are two options for India, if it intends to build up an adequate level of assistance for advanced cancer patients: increase the number of hospital beds (including hospice care); or introduce home care. We have used the home care approach in Italy and found it to be cost-effective.

Costs of the Bologna Hospital-at-Home (BHH) were analysed in 1992 (550 patients) and 1993 (152 patients). Direct and indirect costs were included; no intangible costs were found. The patient's perspective was also analysed. In 1995, an observational study was performed to determine the quality of life of patients admitted to two alternative care settings--the BHH and a traditional hospital, the Ospedale Sant' Orsola Malpighi (OSM), Bologna.

Delivery of services was not different in both settings--the OSM and BHH. The analysis of satisfaction showed that 98% of the BHH patients surveyed felt it matched the actual needs. The quality of life was considered to be 'reduced/bad' in 67% of the OSM patients but in only 51% of BHH patients. With regard to transfer to the alternative setting of nursing, 47% of patients receiving care in the traditional hospital felt that hospital-at-home care would be better. The daily costs for BHH patients ranged between US$ 63.9 and US$ 75.9.

Hospital-at-Home care merits consideration in the palliative care of advanced cancer patients in developing countries. Detailed quality of life studies and cost-benefit assessments would need to be done before such a strategy is implemented. The BHH could be a model adaptable to developing countries. Our first experiences with such a model in Albania and India were encouraging.