title: Cost-effectiveness of a health-social partnership transitional program for post-discharge medical patients.
abstract: BACKGROUND
  Readmissions are costly and have implications for quality of care. Studies have been reported to support effects of transitional care programs in reducing hospital readmissions and enhancing clinical outcomes. However, there is a paucity of studies executing full economic evaluation to assess the cost-effectiveness of these transitional care programs. This study is therefore launched to fill this knowledge gap.
  
  
  METHODS
  Cost-effectiveness analysis was conducted alongside a randomized controlled trial that examined the effects of a Health-Social Transitional Care Management Program (HSTCMP) for medical patients discharged from an acute regional hospital in Hong Kong. The cost and health outcomes were compared between the patients receiving the HSTCMP and usual care. The total costs comprised the pre-program, program, and healthcare utilization costs. Quality of life was measured with SF-36 and transformed to utility values between 0 and 1.
  
  
  RESULTS
  The readmission rates within 28 (control 10.2%, study 4.0%) and 84 days (control 19.4%, study 8.1%) were significantly higher in the control group. Utility values showed no difference between the control and study groups at baseline (p = 0.308). Utility values for the study group were significantly higher than in the control group at 28 (p < 0.001) and 84 days (p = 0.002). The study group also had a significantly higher QALYs gain (p < 0.001) over time at 28 and 84 days when compared with the control group. The intervention had an 89% chance of being cost-effective at the threshold of £20000/QALY.
  
  
  CONCLUSIONS
  Previous studies on transitional care focused mainly on clinical outcomes and not too many included cost as an outcome measure. Studies examining the cost-effectiveness of the post-discharge support services are scanty. This study is the first to examine the cost-effectiveness of a transitional care program that used nurse-led services participated by volunteers. Results have shown that a health-social partnership transitional care program is cost-effective in reducing healthcare costs and attaining QALY gains. Economic evaluation helps to inform funders and guide decisions for the effective use of competing healthcare resources.
authors.affiliation: School of Nursing, The Hong Kong Polytechnic University, Hunghom, Kowloon, Hong Kong, China SAR. frances.wong@polyu.edu.hk
authors.forename: Frances Kam Yuet
authors.initials: FK
authors.lastname: Wong
authors.forename: June
authors.initials: J
authors.lastname: Chau
authors.forename: Ching
authors.initials: C
authors.lastname: So
authors.forename: Stanley Ku Fu
authors.initials: SK
authors.lastname: Tam
authors.forename: Sarah
authors.initials: S
authors.lastname: McGhee
mesh_terms: D016001:Confidence Intervals; D003266:Continuity of Patient Care / Q000191:economics / Q000458:organization & administration; D003362:Cost-Benefit Analysis / Q000379:methods; D006723:Hong Kong; D006801:Humans; D010351:Patient Discharge; D010359:Patient Readmission / Q000191:economics / Q000639:trends; D011788:Quality of Life; D011795:Surveys and Questionnaires