How Much Does a Home Care Nursing Visit Cost? A National Micro-Costing Study from the AIDOMUS-IT Project

Background/Objectives. Country-level evidence on the economic footprint of home care nursing is still scarce, particularly in systems where tariffs for community-based nursing are lacking. In Italy, recent laws have expanded home care; yet planning and funding remain constrained by the absence of robust micro-costing evidence. Objectives. To estimate the accounting cost of home care nursing visits in Italy using a bottom-up micro-costing approach and to identify the main cost drivers influencing expenditure. Methods. A multicentre, cross-sectional study was conducted. Data were collected in two phases: (1) a national survey of 3949 home care nurses from 70 Local Health Authorities (April-October 2023), describing workload, travel time, and the most frequently performed activities; and (2) a time-and-motion study of 527 consecutive home visits performed by 83 nurses in three Local Health Authorities (March 2024). Direct costs were estimated from the Italian National Health Service perspective and included nursing time, travel time and transportation, back-office activities, and materials. Personnel costs were derived from national collective labour agreements and inflation-adjusted. A base-case scenario estimated accounting costs directly measured in the study. An extended, illustrative scenario explored the economic value of nursing activities by applying existing outpatient tariffs. Deterministic and probabilistic sensitivity analyses (10,000-iteration Monte Carlo simulation) were performed. Results. The mean accounting cost of home care nursing was €27.78 per patient per day. At the provider level, the corresponding daily cost per nurse was €190.00, assuming a mean caseload of 6.84 patients per nurse per shift. In the extended scenario, the imputed economic value of nursing activities increased the estimated daily cost to €120.81 per patient and €826.32 per nurse. Sensitivity analyses identified organizational factors (particularly the number of patients per shift and the number of activities per visit) as the dominant cost drivers, while material and transportation costs had a comparatively limited impact. Conclusions. Home care nursing in Italy appears to be delivered at a relatively low accounting cost, with organizational factors playing a greater role than unit prices in determining expenditure. The absence of a dedicated reimbursement framework for nursing activities may result in a substantial under-recognition of the economic value of home-based nursing care. These findings provide preliminary evidence to support workforce planning, reimbursement policies, and the sustainable development of territorial care services.