Home or hospital? An evaluation of the costs, preferences, and outcomes ofdomiciliary chemotherapy

The study compares the costs and outcomes of domiciliary and hospital-based chemotherapy, using a prospective randomized cross-over design. Eighty-sev en eligible patients were recruited from oncology services at two metropoli tan hospitals in Sydney, Australia. Forty patients completed study evaluati on requirements, having two months of chemotherapy in each location (home a nd hospital). The domiciliary service was staffed by hospital-based oncolog y nurses. Marginal costs of domiciliary treatment over hospital treatment w ere estimated from the health service perspective. Home-based care was more expensive, largely due to extra nurse time. About half of the eligible pat ients (n = 87) and 73 percent of the evaluated patients (n = 40) preferred domiciliary care. Most evaluated patients and their informal carers were sa tisfied with the medical care provided, regardless of location. Patient nee ds were well met in either location, and no differences were found in quali ty of life. At current throughput rates, providing chemotherapy in the home was more expensive than providing it in hospital. However, if the demand f or chemotherapy were to exceed ward capacity by up to 50 percent, moving ch emotherapy into the home could provide a less costly strategy for the expan sion of a chemotherapy service without compromising patient outcomes.