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 with 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 acute hospitals. Participants. 199 consecutive patients assessed as being suitable for admission to hospital at home for acute care during the 18 month trial period (median 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 admission. Results. Mean (median) costs per episode (including any transfer from hospital at home to hospital) were similar when analysed by intention to treat-hospital at home £2569 (£1655), hospital ward £2881 (£2031), bootstrap mean difference -305 (95% confidence interval -1112 to 448). When analysis was restricted to those who accepted their allocated place of care, hospital at home was significantly cheaper-hospital at home and £2557 (£1710), hospital ward £3660 (£2903), bootstrap mean difference -1071 (-1843 to -246). At three months the cost differences were sustained. Costs with all cases included were hospital at home £3671 (£2491), hospital ward £3877 (£3405), bootstrap mean difference -210 (-1025 to 635). When only those accepting allocated care were included the costs were hospital at home £3698 (£2493), hospital ward £4761 (£3940), bootstrap mean difference -1063 (-2044 to -163); P = 0.009. About 25% of the costs for episodes of hospital at home were incurred through transfer to hospital. Costs per day of care were higher in the hospital at home arm (mean £207 v £134 in the hospital arm, excluding refusers, P < 0.001). Conclusions. Hospital at home can deliver care at similar or lower cost than an equivalent admission to an acute hospital.