Is comprehensive geriatric assessment hospital at home a cost-effective alternative to hospital admission for older people?

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.

Keywords: admission avoidance hospital at home; comprehensive geriatric assessment; cost-effectiveness; older people.

Figure 1

CONSORT flow diagram of trial participants.

Figure 2

Cost-effectiveness plane showing incremental costs (health and social care perspective) and QALYs, complete cases, using baseline covariate adjustment.