Is comprehensive geriatric assessment hospital at home a cost-effective alternative to hospital admission for older people?

Abstract

Background hospital level healthcare in the home guided by comprehensive geriatric assessment (CGA) might provide a less costly alternative to hospitalisation for older people. Objective to determine the cost-effectiveness of CGA admission avoidance hospital at home (HAH) compared with hospital admission. Design/intervention a cost-effectiveness study alongside a randomised trial of CGA in an admission avoidance HAH setting, compared with admission to hospital. Participants/setting older people considered for a hospital admission in nine locations across the UK were randomised using a 2:1 randomisation schedule to admission avoidance HAH with CGA (N = 700), or admission to hospital with CGA when available (N = 355). Measurements quality adjusted life years, resource use and costs at baseline and 6 months; incremental cost-effectiveness ratios were calculated. The main analysis used complete cases. Results adjusting for baseline covariates, HAH was less costly than admission to hospital from a health and social care perspective (mean −£2,265, 95% CI: −4,279 to −252), and remained less costly with the addition of informal care costs (mean difference −£2,840, 95% CI: −5,495 to −185). There was no difference in quality adjusted survival. Using multiple imputation for missing data, the mean difference in health and social care costs widened to −£2,458 (95% CI: −4,977 to 61) and societal costs remained significantly lower (−£3,083, 95% CI: −5,880 to −287). There was little change to quality adjusted survival. Conclusions CGA HAH is a cost-effective alternative to admission to hospital for selected older people.

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“…The authors report lower unadjusted mean cost in the HaH group (-$5054). This is consistent with a recent economic analysis of a multisite randomised controlled trial of HaH in the UK 5…”

Infective Endocarditis in the Elderly: Challenges and Strategies

“…Outpatient parenteral antibiotic therapy (OPAT) has shown excellent results despite the use of broader selection criteria than those recommended by IDSA [ 10 ] in the recently published experience of the GAMES cohort [ 122 ]. However, OPAT at home, despite being a cost-effective alternative for older people [ 123 ], is not available in most settings, and age-related conditions also complicate attendance at day hospitals for this purpose. The partial oral treatment of endocarditis in clinically stable patients after initial intravenous antibiotic therapy has been shown to be non-inferior to continued intravenous antibiotic treatment in patients (including those ≥ 65 years old) with left heart endocarditis [ 124 , 125 ], also after a 5-year follow-up period [ 126 ].…”

Patients’ experiences of being treated for acute illness at home as an alternative to hospital admission: a qualitative study in Denmark

“…To our knowledge, only a few studies have investigated the efficacy or effectiveness of being treated at home for acute illness versus being hospitalised in a European context, and no studies in a Danish context. Shepperd et al found in a randomised controlled trial (RCT) that a home hospital model for older people provided an alternative to hospitalisation,9 and that hospital at home services can be a cost-effective alternative to hospital admissions for selected older people 10. In the USA, Levine et al compared a home-hospital model with usual hospital care and found that home-hospital care reduced costs, healthcare use and readmissions while increasing physical activity compared with usual hospital care 11.…”

“…Shepperd et al found in a randomised controlled trial (RCT) that a home hospital model for older people provided an alternative to hospitalisation, 9 and that hospital at home services can be a cost-effective alternative to hospital admissions for selected older people. 10 In the USA, Levine et al compared a home-hospital model with usual hospital care and found that home-hospital care reduced costs, healthcare use and readmissions while increasing physical activity compared with usual hospital care. 11 In a qualitative evaluation nested in the same RCT, 11 the results showed that compared with usual hospital care, patients treated at home had better experiences with their care team (nurses and physicians), better sleep, increased physical activity and better experiences with system factors such as admissions processes.…”