title: Economic evaluation of the differential benefits of home visits with telephone calls and telephone calls only in transitional discharge support.
abstract: BACKGROUND
  home visits and telephone calls are two often used approaches in transitional care, but their differential economic effects are unknown.
  
  
  OBJECTIVE
  to examine the differential economic benefits of home visits with telephone calls and telephone calls only in transitional discharge support.
  
  
  METHODS
  cost-effectiveness analysis conducted alongside a randomised controlled trial (RCT).
  
  
  METHODS
  patients discharged from medical units randomly assigned to control (control, N = 210), home visits with calls (home, N = 196) and calls only (call, N = 204).
  
  
  METHODS
  cost-effectiveness analyses were conducted from the societal perspective comparing monetary benefits and quality-adjusted life years (QALYs) gained.
  
  
  RESULTS
  the home arm was less costly but less effective at 28 days and was dominating (less costly and more effective) at 84 days. The call arm was dominating at both 28 and 84 days. The incremental QALY for the home arm was -0.0002/0.0008 (28/84 days), and the call arm was 0.0022/0.0104 (28/84 days). When the three groups were compared, the call arm had a higher probability being cost-effective at 84 days but not at 28 days (home: 53%, call: 35% (28 days) versus home: 22%, call: 73% (84 days)) measuring against the NICE threshold of £20,000.
  
  
  CONCLUSIONS
  the original RCT showed that the bundled intervention involving home visits and calls was more effective than calls only in the reduction of hospital readmissions. This study adds a cost perspective to inform policymakers that both home visits and calls only are cost-effective for transitional care support, but calls only have a higher chance of being cost-effective for a sustained period after intervention.
authors.affiliation: School of Nursing, The Hong Kong Polytechnic University, Hunghom, Kowloon, Hong Kong, China.
authors.forename: Frances Kam Yuet
authors.initials: FK
authors.lastname: Wong
authors.affiliation: Department of Community Medicine, School of Public Health, University of Hong Kong, Hong Kong, China.
authors.forename: Ching
authors.initials: C
authors.lastname: So
authors.affiliation: Department of Community Medicine, School of Public Health, University of Hong Kong, Hong Kong, China.
authors.forename: June
authors.initials: J
authors.lastname: Chau
authors.affiliation: School of Nursing, The Hong Kong Polytechnic University, Hunghom, Kowloon, Hong Kong, China.
authors.forename: Antony Kwan Pui
authors.initials: AK
authors.lastname: Law
authors.affiliation: Department of Medicine, Queen Elizabeth Hospital/Hong Kong Buddhist Hospital, Hong Kong, China.
authors.forename: Stanley Ku Fu
authors.initials: SK
authors.lastname: Tam
authors.affiliation: Department of Community Medicine, School of Public Health, University of Hong Kong, Hong Kong, China.
authors.forename: Sarah
authors.initials: S
authors.lastname: McGhee
mesh_terms: D003266:Continuity of Patient Care / Q000191:economics*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006723:Hong Kong; D006792:House Calls / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D018803:Models, Economic; D010351:Patient Discharge; D010359:Patient Readmission / Q000191:economics; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D013689:Telephone / Q000191:economics*; D013997:Time Factors; D016896:Treatment Outcome
keywords: cost-effectiveness analysis; home visits; hospital readmissions; older people; telephone calls; transitional discharge support