Randomised controlled trial comparing hospital at home care with inpatient hospital care. II: cost minimisation analysis.
OBJECTIVE
To examine the cost of providing hospital at home in place of some forms of inpatient hospital care.


METHODS
Cost minimisation study within a randomised controlled trial.


METHODS
District general hospital and catchment area of neighbouring community trust.


METHODS
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).


METHODS
Hospital at home or inpatient hospital care.


METHODS
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.


CONCLUSIONS
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.
Shepperd
S
S
Division of Public Health and Primary Health Care, University of Oxford, Institute of Health Sciences, Headington, Oxford OX3 7LF. Sasha.Shepperd@dphpc.ox.ac.uk
Harwood
D
D
Gray
A
A
Vessey
M
M
Morgan
P
P
D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000191:economics / Q000534:rehabilitation; D019645:Arthroplasty, Replacement, Knee / Q000191:economics / Q000534:rehabilitation; D017558:Elective Surgical Procedures / Q000191:economics / Q000534:rehabilitation; D004739:England; D005194:Family Practice / Q000191:economics; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D018575:Home Care Services, Hospital-Based / Q000191:economics* / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006767:Hospitals, District / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008173:Lung Diseases, Obstructive / Q000191:economics / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity