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. 2024 Apr 15;22(1):30.
doi: 10.1186/s12962-024-00536-1.

The value of admission avoidance: cost-consequence analysis of one-year activity in a consolidated service

Carme Hernandez  1   2 , Carme Herranz  3   4 , Erik Baltaxe  3   5 , Nuria Seijas  6 , Rubèn González-Colom  3 , Maria Asenjo  6 , Emmanuel Coloma  6   7 , Joaquim Fernandez  3   7 , Emili Vela  8   9 , Gerard Carot-Sans  8   9 , Isaac Cano  3 , Josep Roca  6   3   10 , David Nicolas  6   7
Affiliations

The value of admission avoidance: cost-consequence analysis of one-year activity in a consolidated service

Carme Hernandez et al. Cost Eff Resour Alloc. .

Abstract

Background: Many advantages of hospital at home (HaH), as a modality of acute care, have been highlighted, but controversies exist regarding the cost-benefit trade-offs. The objective is to assess health outcomes and analytical costs of hospital avoidance (HaH-HA) in a consolidated service with over ten years of delivery of HaH in Barcelona (Spain).

Methods: A retrospective cost-consequence analysis of all first episodes of HaH-HA, directly admitted from the emergency room (ER) in 2017-2018, was carried out with a health system perspective. HaH-HA was compared with a propensity-score-matched group of contemporary patients admitted to conventional hospitalization (Controls). Mortality, re-admissions, ER visits, and direct healthcare costs were evaluated.

Results: HaH-HA and Controls (n = 441 each) were comparable in terms of age (73 [SD16] vs. 74 [SD16]), gender (male, 57% vs. 59%), multimorbidity, healthcare expenditure during the previous year, case mix index of the acute episode, and main diagnosis at discharge. HaH-HA presented lower mortality during the episode (0 vs. 19 (4.3%); p < 0.001). At 30 days post-discharge, HaH-HA and Controls showed similar re-admission rates; however, ER visits were lower in HaH-HA than in Controls (28 (6.3%) vs. 34 (8.1%); p = 0.044). Average costs per patient during the episode were lower in the HaH-HA group (€ 1,078) than in Controls (€ 2,171). Likewise, healthcare costs within the 30 days post-discharge were also lower in HaH-Ha than in Controls (p < 0.001).

Conclusions: The study showed higher performance and cost reductions of HaH-HA in a real-world setting. The identification of sources of savings facilitates scaling of hospital avoidance.

Registration: ClinicalTrials.gov (26/04/2017; NCT03130283).

Keywords: Early readmissions; Health services research; Hospital at home; Implementation science; Transitional care.

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Conflict of interest statement

All authors have disclosed no conflicts of interest.

Figures

Fig. 1
Fig. 1
Number and distribution of patients. Five-hundred eighty-six first episodes of HaH admissions, directly from the Emergency Room (HaH-HA), were registered during the study period. After propensity score matching, the HaH-HA group fell to 441 patients (Comparisons among the two study groups and the study population of 586 patients are reported in Tables 1S, 3 S and 4 S, see text for details)
Fig. 2
Fig. 2
Average cost per pacient. In the left panel, the two columns indicate the average cost per patient for HaH-HA (Hospital at Home-Hospital Avoidance) and matched Controls (conventional hospitalizations), respectively. The colors indicate the weight of the different cost components (see text for details). The right panel depicts the box plots of the cost analysis
See this image and copyright information in PMC

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