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

Abstract

to compare the cost effectiveness of post-acute care for older people provided in community hospitals with general hospital care. cost-effectiveness study embedded within a randomised controlled trial. seven community hospitals and five general hospitals at five centres in the midlands and north of England. 490 patients needing rehabilitation following hospital admission with an acute illness. multidisciplinary team care for older people in community hospitals. EuroQol EQ-5D scores transformed into quality-adjusted life years; health and social service costs during the 6-month period following randomisation. 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. the cost effectiveness of post-acute rehabilitation for older people was similar in community hospitals and general hospitals.