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Published on: September 30, 2020
Post-acute care for older people in community hospitals--a cost-effectiveness analysis within a multi-centre
Jacqueline O'Reilly1, Karin Lowson, John Green
1Health Research and Information Division, Economic and Social Research Institute, Dublin, Ireland.
Objectives:
to compare the cost effectiveness of post-acute care for older people provided in community hospitals with general hospital care.
Design:
cost-effectiveness study embedded within a randomised controlled trial.
Setting:
seven community hospitals and five general hospitals at five centres in the midlands and north of England.
Participants:
490 patients needing rehabilitation following hospital admission with an acute illness.
Intervention:
multidisciplinary team care for older people in community hospitals.
Measurements:
EuroQol EQ-5D scores transformed into quality-adjusted life years; health and social service costs during the 6-month period following randomisation.
Results:
there was a non-significant difference between the community hospital and general hospital groups for changes in quality-adjusted life-year values from baseline to 6 months (mean difference 0.048; 95% confidence interval -0.028 to 0.123; P = 0.214). Resource use was similar for both groups. The mean (standard deviation) costs per patient for health and social services resources used were comparable for both groups: community hospital group 8,946 pounds ( 6,514 pounds); general hospital group 8,226 pounds ( 7,453 pounds). These findings were robust to sensitivity analyses. The incremental cost-effectiveness ratio estimate was 16,324 pounds per quality-adjusted life year. A cost effectiveness acceptability curve suggests that if decision makers' willingness to pay per quality-adjusted life year was 10,000 pounds, then community hospital care was effective in 47% of cases, and this increased to only 50% if the threshold willingness to pay was raised to 30,000 pounds.
Conclusions:
the cost effectiveness of post-acute rehabilitation for older people was similar in community hospitals and general hospitals.
