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Randomised controlled trial comparing hospital at home care with inpatient hospital care. II: cost minimisation
S Shepperd1, D Harwood, A Gray
1Division of Public Health and Primary Health Care, University of Oxford, Institute of Health Sciences, Headington, Oxford OX3 7LF. Sasha.Shepperd@dphpc.ox.ac.uk
Objectives:
To examine the cost of providing hospital at home in place of some forms of inpatient hospital care.
Design:
Cost minimisation study within a randomised controlled trial.
Setting:
District general hospital and catchment area of neighbouring community trust.
Subjects:
Patients recovering from hip replacement (n=86), knee replacement (n=86), and hysterectomy (n=238); elderly medical patients (n=96); and patients with chronic obstructive airways disease (n=32).
Interventions:
Hospital at home or inpatient hospital care.
Main Outcome Measures:
Cost of hospital at home scheme to health service, to general practitioners, and to patients and their families compared with hospital care.
Results:
No difference was detected in total healthcare costs between hospital at home and hospital care for patients recovering from a hip or knee replacement, or elderly medical patients. Hospital at home significantly increased healthcare costs for patients recovering from a hysterectomy (ratio of geometrical means 1.15, 95% confidence interval 1.04 to 1.29, P=0.009) and for those with chronic obstructive airways disease (Mann-Whitney U test, P=0.01). Hospital at home significantly increased general practitioners' costs for elderly medical patients (Mann-Whitney U test, P<0.01) and for those with chronic obstructive airways disease (P=0.02). Patient and carer expenditure made up a small proportion of total costs.
Conclusion:
Hospital at home care did not reduce total healthcare costs for the conditions studied in this trial, and costs were significantly increased for patients recovering from a hysterectomy and those with chronic obstructive airways disease. There was some evidence that costs were shifted to primary care for elderly medical patients and those with chronic obstructive airways disease.