Post-acute care for older people in community hospitals--a cost-effectiveness analysis within a multi-centre randomised controlled trial.

摘要

OBJECTIVES: to compare the cost effectiveness of post-acute care for older people provided in community hospitals with general hospital care. DESIGN: cost-effectiveness study embedded within a randomised controlled trial. SETTING: seven community hospitals and five general hospitals at five centres in the midlands and north of England. Participants: 490 patients needing rehabilitation following hospital admission with an acute illness. Intervention: multidisciplinary team care for older people in community hospitals. MEASUREMENTS: EuroQol EQ-5D scores transformed into quality-adjusted life years; health and social service costs during the 6-month period following randomisation. RESULTS: there was a non-significant difference between the community hospital and general hospital groups for changes in quality-adjusted life-year values from baseline to 6 months (mean difference 0.048; 95% confidence interval -0.028 to 0.123; P = 0.214). Resource use was similar for both groups. The mean (standard deviation)costs per patient for health and social services resources used were comparable for both groups: community hospital group 8,946 pounds ( 6,514 pounds); general hospital group 8,226 pounds ( 7,453 pounds). These findings were robust to sensitivity analyses. The incremental cost-effectiveness ratio estimate was 16,324 pounds per quality-adjusted life year. A cost effectiveness acceptability curve suggests that if decision makers' willingness to pay per quality-adjusted life year was 10,000 pounds, then community hospital care was effective in 47% of cases, and this increased to only 50% if the threshold willingness to pay was raised to 30,000 pounds. CONCLUSIONS: the cost effectiveness of post-acute rehabilitation for older people was similar in community hospitals and general hospitals.