RANDOMIZED CONTROLLED TRIAL COMPARING HOSPITAL AT HOME CARE WITH INPATIENT HOSPITAL-CARE - II - COST MINIMIZATION ANALYSIS

Objectives: To examine the cost of providing hospital at home in place of some for ms of inpatient hospital care, Design: Cost minimisation study within a randomised controlled trial. Setting: District general hospital and catchment area of neighbouring community trust. Subjects: 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), Inte rventions: Hospital at home or inpatient hospital care. Main outcome m easures: Cost of hospital at home scheme to health sen ice, to general practitioners, and to patients and their families compared with hospi tal care. Results: No difference was detected in total healthcare cost s between hospital at home and hospital care for patients recovering f rom 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 obstructi ve airways disease (Mann-Whitney U test, P = 0.01). Hospital at home s ignificantly increased general practitioners' costs for elderly medica l patients (Mann-Whitney U test P < 0.01) and for those with chronic o bstructive airways disease (P = 0.02), Patient and carer expenditure m ade up a small proportion of total costs. Conclusion: Hospital at home care did not reduce total healthcare costs for the conditions studied in this trial, and costs were significantly increased for patients re covering fi-om a hysterectomy and those with chronic obstructive airwa ys disease, There was some evidence that costs were shifted to primary care for elderly medical patients and those with chronic obstructive airways disease.