Economic evaluation of hospital at home versus hospital care: cost minimisation analysis of data from randomised controlled trial

Objectives To compare the costs of admission to a hospital at home scheme w ith those of acute hospital admission. Design Cost minimisation analysis within a pragmatic randomised controlled trial. Setting Hospital at home scheme in Leicester and the city's three ac ute hospitals. Participants 199 consecutive patients assessed as being suitable for admiss ion to hospital at home for acute care during the 18 month trial period (me dian age 84 years). Intervention Hospital at home or hospital inpatient care. Main outcome measures Costs to NHS, social services, patients, and families during the initial episode of treatment and the three months after admissi on. Results Mean (median) costs per episode (including any transfer from hospit al at home to hospital) were similar when analysed by intention to treat-ho spital at home pound f2569 (pound 1655), hospital ward pound 2881 (pound 20 31), bootstrap mean difference -305 (95% confidence interval -1112 to 448). When analysis was restricted to those who accepted their allocated place o f care, hospital at home was significantly cheaper-hospital at home pound 2 557 (pound 1710), hospital ward pound 3660 (pound 2903), bootstrap mean dif ference - 1071 (-1843 to -246). At thee months the cost differences were su stained. Costs with all cases included were hospital at home pound 3671 (po und 2491), hospital ward pound 3877 (pound 3405), bootstrap mean difference -210 (-1025 to 635). When only those accepting allocated care were include d the costs were hospital at home pound 3698 (pound 2493), hospital ward po und 4761 (pound 3940), bootstrap mean difference -1063 (-2044 to -163); P = 0.009. About 25% of the costs for episodes of hospital at home were incurr ed through transfer to hospital. Costs per day of care were higher in the h ospital at home arm (mean pound 207 v pound 134 in the hospital arm, exclud ing refusers, P < 0.001). Conclusions Hospital at home can deliver care at similar or lower cost than an equivalent admission to an acute hospital.