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

• Published in: Cost effectiveness and resource allocation Vol. 22; no. 1; p. 30
• Main Authors: Hernandez, Carme, Herranz, Carme, Baltaxe, Erik, Seijas, Nuria, González-Colom, Rubèn, Asenjo, Maria, Coloma, Emmanuel, Fernandez, Joaquim, Vela, Emili, Carot-Sans, Gerard, Cano, Isaac, Roca, Josep, Nicolas, David
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 15-04-2024; BioMed Central; BMC
• Subjects: Analysis; Clinical outcomes; Cost analysis; Cost benefit analysis; Costs; Early readmissions; Economic aspects; Emergency medical care; Emergency medical services; Health aspects; Health care expenditures; Health services research; Home health care; Hospital at home; Hospitalization; Hospitals; Implementation science; Medical economics; Mortality; Patient satisfaction; Patients; Primary care; Quality control; Reimbursement; Spain; Transitional care; Spain; Hospital at home; Transitional care; Early readmissions; Implementation science; Health services research
• ISSN: 1478-7547; 1478-7547
• DOI: 10.1186/s12962-024-00536-1

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