Singh S, Gray A, Shepperd S, Stott DJ, Ellis G, Hemsley A, Khanna P, Ramsay S, Schiff R, Tsiachristas A, Wilkinson A, Young J. Is comprehensive geriatric assessment hospital at home a cost-effective alternative to hospital admission for older people?
Age Ageing 2022;
51:afab220. [PMID:
34969074 PMCID:
PMC8753046 DOI:
10.1093/ageing/afab220]
[Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/15/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND
hospital level healthcare in the home guided by comprehensive geriatric assessment (CGA) might provide a less costly alternative to hospitalisation for older people.
OBJECTIVE
to determine the cost-effectiveness of CGA admission avoidance hospital at home (HAH) compared with hospital admission.
DESIGN/INTERVENTION
a cost-effectiveness study alongside a randomised trial of CGA in an admission avoidance HAH setting, compared with admission to hospital.
PARTICIPANTS/SETTING
older people considered for a hospital admission in nine locations across the UK were randomised using a 2:1 randomisation schedule to admission avoidance HAH with CGA (N = 700), or admission to hospital with CGA when available (N = 355).
MEASUREMENTS
quality adjusted life years, resource use and costs at baseline and 6 months; incremental cost-effectiveness ratios were calculated. The main analysis used complete cases.
RESULTS
adjusting for baseline covariates, HAH was less costly than admission to hospital from a health and social care perspective (mean -£2,265, 95% CI: -4,279 to -252), and remained less costly with the addition of informal care costs (mean difference -£2,840, 95% CI: -5,495 to -185). There was no difference in quality adjusted survival. Using multiple imputation for missing data, the mean difference in health and social care costs widened to -£2,458 (95% CI: -4,977 to 61) and societal costs remained significantly lower (-£3,083, 95% CI: -5,880 to -287). There was little change to quality adjusted survival.
CONCLUSIONS
CGA HAH is a cost-effective alternative to admission to hospital for selected older people.
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