1.13. Analysis.

Comparison 1: Admission avoidance hospital at home versus inpatient care, Outcome 13: Cost and resource use

Cost and resource use
Study	Outcomes	Results	Notes
Health service resources and costs
Caplan 1999	Cost	Average cost per episode, mean (SD) T= $1,764 ($1,253), C= $3,775 ($2,496) Mean difference per episode $‐2011 Cost per day, mean (SD) T= $191 ($58), C= $484 ($67.23) Mean difference per day ‐$293	Cost data financial year 1995/1996
Corwin 2005	Days on oral antibiotics	HR 1.09 (0.82 to 1.45), P = 0.56
Echevarria 2018	Health and formal social care costs	Mean health and formal social care costs (SD) T = 3857.8 (3199.6) C = 4873.5 (5631.1) Bootstrapped mean difference (95% CI) ‐1015.7 (‐2735.5, 644.8)
Levine 2018	Relative cost reduction of acute care episode Relative cost reduction of acute care episode and 30 days after acute care episode	Relative cost reduction of acute care episode, % 52% (IQR, 28%; p = 0.05) Relative cost reduction of acute care episode and 30 days after, % 67% (IQR, 77%; p<0.01)	% lower than for control patients Change in median cost
Levine 2020	Relative cost reduction of acute care episode (including physician cost, Appendix Table 7 (Levine 2020) Relative cost reduction of acute care episode and 30 days after acute care episode	With physician labour Adjusted relative reduction in cost of acute care episode, % (95% CI) 19 (4, 31) P=0.017 Adjusted relative reduction in cost of acute care episode and 30 days after, % (95% CI) 25 (10,38) P<0.001	Positive means home group costs less Relative reduction in mean cost (%)
Mendoza 2009	Cost	Mean (SD) T= €2,541 (1,334), C= €4,502 (2,153) Difference €1,961 P < 0.0001	Difference attributed to fewer investigations. Costs include health service costs used during follow‐up period of 1 year, excludes informal care.
Nicholson 2001	Costs	Cost per episode, mean (95% C) T= $745 ($595 to $895),C= $2543 ($1766 to $3321) Difference $1798, P < 0.01 Hospital at home costs 29% of the average hospital managed patient episode. Reported cost effectiveness ratio of 3:1 T + C costs GP 10% of costs, Domiciliary allied health 21% of costs, community nursing 28% of costs = 59% of costs and hospital care 41% of costs. If C=$895 then T= $1287 (59% of costs) Total costs=$2182 per patient episode of care	Costs based on financial year 99/00; Used average DRG costs (Australian $), patient data for ED costs, and modelled costs for OPD clinic visits. HAH care individual costs, included direct and non direct costs. GP costs at $91.00 per hour.
Ricauda 2004	Mean total cost (EUR converted to US$ 1 Euro=$1.3)	T= $6 413.5 per patient, C= $6 504.8 per patient Cost per patient per day (SD) T= $163 (20.5), C= $275.6 (27.7) P < 0.001
Ricauda 2008	Hospital at home resources Total costs	Nursing visits (range) T= 14.1 (3 to 38) Physician visits T= 9.9 (2 to 28) Visits to hospital for diagnosis T= 11 Total mean cost per patient T=$1,175.9, C= $1,390.9, P = 0.38 Total mean cost per day (SD) T= $101.4 (61.3), C= 151.7 (96.4)
Richards 2005	Cost based on DRGs for control and actual cost for intervention	Mean cost per patient NZ$ T= $1157.9, C= $1556.28
Shepperd 2021	Health and social care costs	Mean cost of initial admission (SD) T = 1742 (3234) C = 3723 (5095) Mean difference: ‐1981 (‐2551, ‐1411) Mean Health and Social care cost (adjusted), baseline to 6 months follow up T = 15,124 C = 17,390 Mean difference: ‐2265 (‐4279, ‐252) Mean Societal costs (adjusted), baseline to 6 month follow up T = 19,067 C = 21,907 Mean difference: ‐2,840 (‐5,495, ‐185)
Wilson 1999	Cost	Cost of initial episode (95% CI) T= £2,568.9 (2,089.3 to 2,972.1) C= £2,880.6 (2,316.1 to 3,547.8) Difference ‐311.7, P > 0.43 Bootstrap difference using 1000 subsamples: ‐304.72 (‐1,112.4 to 447.9). Mean cost per day (95% CI) T= £204.6 (91.5 to 118.4) C= £104.9 £ (181.1 to 228.22) Mean difference £99.71 P < 0.001 Cost at 3 months (95% CI) T= £3,671.3 (3,140.5 to 4,231.3) C= £3,876.9 (3,224.51 to 4,559.6) Difference ‐205.7, P > 0.65 Bootstrap difference using 1000 subsamples: ‐210.9 (‐1,025 to 635.5) COSTS EXCLUDING REFUSERS Cost of initial episode, mean (95% CI) T= £2,594.4 (£2,170.36 to £3,143.5) C= £3,659.20 (£3,140.46 to £4,231.28) Mean difference ‐£1,064.79, P < 0.01. Bootstrap mean difference £1070.53, (95% CI‐£1843.2 to ‐£245.73) 95% CI derived using bootstrap method with 1000 subsamples Cost per day, mean (95% CI) T= £206.68 (£183.21 to £230.14) C= £133.7 (£124.6 to £142.8) Mean difference £72.98, P < 0.001 Cost at 3 months, mean (95% CI) T= £3,697.5 (£3136.13 to £4330.66) C= £4,761.3 (£4105.6 to £5476.6) Mean difference ‐£1,063.8, p = 0.025 Bootstrap mean difference: £1,063.45 (95% CI ‐£2043.8 to ‐£162.7)	Cost data financial year 1995/1996 BNF for medicines 1995
Use of other social services
Davies 2000	While receiving hospital at home care, or on discharge from hospital	Referred for increased social support T= 24/100 (24%), C= 3/50 (6%) Difference 18%, 95% CI 7.3% to 28.6%
Echevarria 2018	Patients with a social care package post discharge	Patients with a social care package post discharge (%) T = 7 (11.7) C = 5 (8.6)
Informal care inputs
Kalra 2000	Informal care inputs	Received informal care: T= 100/140 (71%), C= 98/147 (67%), Difference 4.8%, 95% CI ‐5.9% to 15.3% Total from co residents over 12 months, hours (SD) T= 899.18 (1760), C= 718 (6778), P = 0.75 Total hours per average week from co residents (SD) T=46.38 (48.15), C= 33.71 (44.35), P = 0.02 Total hours from nonresidents over 12 months (SD) T= 79.7 (283), C= 127.44 (348), P = 0.27 Total average hours per week from non residents T= 4.79 (16.51), C= 5.03 (11.54), P = 0.88 Total hours over 12 months (SD) T= 979 (1749), C= 846 (1549), P = 0.49
Shepperd 2021	Informal care	Mean total number of hours of unpaid help over the last 6 months (SD) T = 594.89 (1093.63) C = 657.64 (1170.87) Difference in means (95% CI): ‐62.76 (‐224.61, 99.09)