Cancer treatment at home or in the hospital: what are the costs for French public health insurance? Findings of a comprehensive-cancer centre.
OBJECTIVE
The objective of this study was to evaluate the cost of home-cancer-healthcare programs and their potential interest for public health insurance as compared to inpatient cancer care.


METHODS
The study was conducted at the Centre Leon Berard (CLB), a comprehensive cancer centre in Lyon, France. Hospitals at home patients were monitored by nurses and oncologists from the CLB. All patients, who received home treatment over a 15-day period in 2001, were included in the study. Patients were broken down into groups according to the type of healthcare required and the corresponding impact on health insurance expenditure. For each of these patients, a fictive-hospital stay was then reconstructed, which corresponded to the inpatient hospital care that would have been required during the observation period, had hospital at home not been available.


RESULTS
The average cost of hospital at home was significantly lower than the corresponding estimated cost for treatment at the hospital (776.6 versus 2012.5, P < 0.001). This difference was particularly high for patients in the "palliative care" group (N = 33) (1201.7 versus 3489.7, P < 0.001), whereas in the "chemotherapy" group, results were not significantly different (N = 34) (225.5 versus 318).


CONCLUSIONS
Our study suggests that hospitalisation alternatives can generate substantial savings for public health insurance in France.
Raphaël
Remonnay
R
LASS-GRESAC, CNRS UMR 5823, Université Claude Bernard-Lyon 1, France. remonnay@lyon.fnclcc.fr
Yves
Devaux
D
Giselle
Chvetzoff
C
Magali
Morelle
M
Odile
Carrere Marie
CM
D000328:Adult; D000368:Aged; D002173:Cancer Care Facilities / Q000458:organization & administration*; D005260:Female; D005602:France; D006699:Home Care Services / Q000191:economics*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*; D009369:Neoplasms / Q000188:drug therapy / Q000628:therapy*