Using cost-effectiveness analysis to compare Hospital at Home and in-patient interventions. Part 2

An economic analysis was conducted as an integral part of a comparison of the effectiveness and suitability of Hospital at Home (HaH) and in-patient interventions. The sample comprised 109 adult primary total joint replacement patients and 21 of their co-resident informal carers. Part 2 is principally a methodology paper and describes how nurses may use a variety of methods to compare cost between treatment modalities. A Cost-Effectiveness Analysis framework uses the data from Paper 1 to calculate the economic feasibility of HaH compared with traditional in-patient interventions as a worked example of how the principles of economic analysis can be used within health care research. The basic information for calculating cost of both interventions was obtained by multiplying the mean length of total treatment days by the cost per treatment day. However calculating and comparing cost for in-patient and HaH modalities was multifaceted and included costs incurred by patients and families as well as any shift in cost from tertiary to community and outpatient services. Application of the cost-effectiveness analysis framework demonstrated that not only was HaH more effective than in-patient care in several aspects, but also it was less costly because of a mean reduction in length of stay of 0.9 days per patient and a significant reduction in cost per treatment day because of removal of hospital overhead costs and reduced special duty payments even when offset against additional transport, community and outpatient costs.