Hospital at home or acute hospital care? A cost minimisation analysis

Objective: To compare, from the viewpoints of the NHS and social services and of patients, the costs associated with early discharge to a hospital at home scheme and those associated with continued care in an acute hospital. Design: Cost minimisation analysis. Setting: Acute hospital wards and the community in the north of Bristol (population about 224 000). Subjects: 241 hospitalised but medically stable elderly patients who fulfilled the criteria for early discharge to a hospital at home scheme and who consented to participate. Main outcome measures: Costs to the NHS, social services, and patients over the 3 months after randomisation. Results: The mean cost for hospital at home patients over the 3 months was £2516, whereas that for hospital patients was £3292. Under all the assumptions used in the sensitivity analysis, the cost of hospital at home care was less than that of hospital care. Only when hospital costs were assumed to be less than 50% of those used in the initial analysis was the difference equivocal. Conclusions: The hospital at home scheme is less costly than care in the acute hospital. These results may be generalisable to schemes of similar size and scope, operating in a similar context of rising acute admissions.