IS DAY-CARE EQUIVALENT TO INPATIENT CARE FOR ACTIVE RHEUMATOID-ARTHRITIS - RANDOMIZED CONTROLLED CLINICAL AND ECONOMIC-EVALUATION

Objective: To test the clinical equivalence and resource consequences of day care with inpatient care for active rheumatoid arthritis. Desig n: Randomised controlled clinical trial with integrated cost minimisat ion economic evaluation. Setting: Rheumatic diseases unit at a teachin g hospital between 1994 and 1996.Subjects: 118 consecutive patients wi th active rheumatoid arthritis randomised to receive either day care o r inpatient care. Main outcome measures: Clinical assessments recorded on admission, discharge, and follow up at 12 months comprised: the he alth assessment questionnaire, Ritchie articular index, erythrocyte se dimentation rate, hospital anxiety and depression scale, and Steinbroc ker functional class. Resource estimates were of the direct and indire ct costs relating to treatment for rheumatoid arthritis. Secondary out come measures (health utility) were ascertained by time trade off and with the quality of well being scale. Results: Both groups had improve ment in scores on the health assessment questionnaire and Ritchie inde x and erythrocyte sedimentation rate after hospital treatment (P < 0.0 001) but clinical outcome did not differ significantly between the gro ups either at discharge or follow up. The mean hospital cost per patie nt for day care, pound 798 (95% confidence interval pound 705 to pound 888), was lower than for inpatient care, pound 1253 (pound 1155 to po und 1370), but this difference was offset by higher community travel, and readmission costs. The difference in total cost per patient betwee n day care and inpatient care was small (pound 1789 (pound 1539 to pou nd 2027) v pound 2021 (pound 1834 to pound 2230)). Quantile regression analysis showed a cost difference in favour of day care up to the 50t h centile (pound 374; pound 639 to pound 109). Conclusions: Day care a nd inpatient care for patients with uncomplicated active rheumatoid ar thritis have equivalent clinical outcome with a small difference in ov erall resource cost in favour of day care. The choice of management st rategy may depend increasingly on convenience, satisfaction, or more c omprehensive health measures reflecting the preferences of patients, p roviders, and service commissioners.