Cost-Effectiveness Analysis Of A Hospital Care At Home Program Versus Inpatient Hospital Care In Patients Of The Mexican Institute Of Social Security In Mexico City

Abstract Aims: This study evaluated and compared the cost-effectiveness of rehabilitation interventions in patients with stroke in the three alternatives of hospitals, units and homes due to the fact that one of the stroke management challenges is how to provide a rehabilitation service to these patients in Iran. Methods: This is a cost-effectiveness analysis from the perspective of a health system. A Markov model with a 20-year time horizon in 3-month cycles was used to analyze the costs and outcomes. Cost data were collected from the 210 patients undergoing rehabilitation in the hospital, home and unit. Utility data were extracted from previously published literature with the same setting. The cost-effectiveness analysis was conducted by calculating ICER using TreeAge Software. Basic and probabilistic sensitivity analyses were also conducted at the end. Results: The average cost of rehabilitation in home strategy ($ 2306) was less than hospital ($2955) and unit ($3485) strategies. Furthermore, the utility of home strategy (26.03) was 8 units higher than hospital utility (17.99) and 19 units higher than utility of the stroke unit (7.03). The Acer values of hospital, stroke unit and home groups were $11424, $33159 and $7233 per utility, respectively. According to the results, the home-based rehabilitation strategy is cost effective compared to hospital and unit rehabilitation strategy. The results of the probabilistic sensitivity analysis also showed that the ICER of home strategy is always cost-effective than the other strategies. Limitation: : limitation of the present study was the reliance on utility values of other studies. Conclusion: Rehabilitation at home is the most cost-effective strategy for stroke patients. Given the high rates of this disease in Iran and the high cost of it, it is suggested that policy makers lay the groundwork for providing these services at home.

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Using cost-effectiveness analysis to compare Hospital at Home and in-patient interventions. Part 2

Journal of Clinical Nursing ◽

10.1046/j.1365-2702.2003.00686.x ◽

2003 ◽

Vol 12 (1) ◽

pp. 20-27 ◽

Cited By ~ 13

Author(s):

Rebecca Jester ◽

Carolyn Hicks

Keyword(s):

Cost Effectiveness ◽

Cost Effectiveness Analysis ◽

Effectiveness Analysis ◽

Hospital At Home ◽

At Home

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Using cost-effectiveness analysis to compare Hospital at Home and in-patient interventions. Part 1

Journal of Clinical Nursing ◽

10.1046/j.1365-2702.2003.00685.x ◽

2003 ◽

Vol 12 (1) ◽

pp. 13-19 ◽

Cited By ~ 9

Author(s):

Rebecca Jester ◽

Carolyn Hicks

Keyword(s):

Cost Effectiveness ◽

Cost Effectiveness Analysis ◽

Effectiveness Analysis ◽

Hospital At Home ◽

At Home

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Cervical ripening at home or in-hospital—prospective cohort study and process evaluation (CHOICE) study: a protocol

BMJ Open ◽

10.1136/bmjopen-2021-050452 ◽

2021 ◽

Vol 11 (5) ◽

pp. e050452

Author(s):

Sarah Jane Stock ◽

Amarnath Bhide ◽

Heather Richardson ◽

Mairead Black ◽

Cassandra Yuill ◽

...

Keyword(s):

Cohort Study ◽

Cost Effectiveness ◽

Incremental Cost ◽

Process Evaluation ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Cost Effectiveness Analysis ◽

Cervical Ripening ◽

Effectiveness Analysis ◽

At Home

IntroductionThe aim of the cervical ripening at home or in-hospital—prospective cohort study and process evaluation (CHOICE) study is to compare home versus in-hospital cervical ripening to determine whether home cervical ripening is safe (for the primary outcome of neonatal unit (NNU) admission), acceptable to women and cost-effective from the perspective of both women and the National Health Service (NHS).Methods and analysisWe will perform a prospective multicentre observational cohort study with an internal pilot phase. We will obtain data from electronic health records from at least 14 maternity units offering only in-hospital cervical ripening and 12 offering dinoprostone home cervical ripening. We will also conduct a cost-effectiveness analysis and a mixed methods study to evaluate processes and women/partner experiences. Our primary sample size is 8533 women with singleton pregnancies undergoing induction of labour (IOL) at 39+0 weeks’ gestation or more. To achieve this and contextualise our findings, we will collect data relating to a cohort of approximately 41 000 women undergoing IOL after 37 weeks. We will use mixed effects logistic regression for the non-inferiority comparison of NNU admission and propensity score matched adjustment to control for treatment indication bias. The economic analysis will be undertaken from the perspective of the NHS and Personal Social Services (PSS) and the pregnant woman. It will include a within-study cost-effectiveness analysis and a lifetime cost–utility analysis to account for any long-term impacts of the cervical ripening strategies. Outcomes will be reported as incremental cost per NNU admission avoided and incremental cost per quality adjusted life year gained.Research ethics approval and disseminationCHOICE has been funded and approved by the National Institute of Healthcare Research Health Technology and Assessment, and the results will be disseminated via publication in peer-reviewed journals.Trial registration numberISRCTN32652461.

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