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

• Published in: Age and ageing 2022-01, Vol.51 (1)
• Main Authors: Singh, Surya, Gray, Alastair, Shepperd, Sasha, Stott, David J, Ellis, Graham, Hemsley, Anthony, Khanna, Pradeep, Ramsay, Scott, Schiff, Rebekah, Tsiachristas, Apostolos, Wilkinson, Angela, Young, John
• Format: Article
• Language: English
• Subjects: Aged; Cost-Benefit Analysis; Geriatric Assessment; Hospitalization; Hospitals; Humans; Quality-Adjusted Life Years; Research Paper
• ISSN: 0002-0729; 1468-2834
• DOI: 10.1093/ageing/afab220

hospital level healthcare in the home guided by comprehensive geriatric assessment (CGA) might provide a less costly alternative to hospitalisation for older people. to determine the cost-effectiveness of CGA admission avoidance hospital at home (HAH) compared with hospital admission. a cost-effectiveness study alongside a randomised trial of CGA in an admission avoidance HAH setting, compared with admission to hospital. 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). 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. 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. CGA HAH is a cost-effective alternative to admission to hospital for selected older people.