Table 4. HELP Program impact on cost savings.

Study	Sample size/site	Study Description	Methodology/Cost Savings Calculations
Bakker 2013	28 patients, 1 site	Before-after study with preintervention control and postintervention groups. HELP program was implemented; feasibility was examined and preliminary research data gathered.	Mean cumulative costs per patient three months after discharge were $11,979 for intervention group vs. $14,743 for control = $2,764 total savings per patient
C. Chen 2017	179 patients, 1 site	Cluster-randomized controlled trial. Modified HELP program (3 key interventions) was implemented for abdominal surgery patients in Taiwan.	Cost savings calculated by applying cost savings from prior studies. For example, mHELP could have prevented delirium in approximately 674,576 surgical patients, resulting in a Medicare cost savings of approximately $10,000 per case or $6.7 billion for the year. By cutting 2 days from LOS, mHELP could have saved $1624 per hospital stay or $12.9 billion per year in Medicare costs for hospitalization.
Caplan 2007	37 patients, 1 site	Two historical controlled studies of HELP implementation.	Cost savings calculated by applying rates from hospitals in Australia. $67,876 per year saved by decreasing length of stay through delirium prevention. $91,678 per year saved on hospital sitter costs for patients with hyperactive delirium.
Leslie 2005	801 patients, 1 site	From controlled clinical trial, compared intervention and control groups for long-term nursing home costs when HELP was received during prior hospitalization.	HELP had significantly lower total nursing home costs, shorter length of stay and lower cost per survival day. Adjusted total costs were $50,881 per patient in HELP and $60,327 in control group = $9446 savings per patient (15.7%, p = 0.01).
Leslie 2008	835 patients, 1 site	From controlled clinical trial, determined additional costs in control group for delirium (compared with intervention group) for 1-year health care costs associated with delirium.	Total cost estimates attributable to delirium was $16,303-$64,421 per patient; thus, the national burden of delirium was estimated at $38–152 billion each year (after adjusting for pertinent demographic and clinical characteristics)
Rizzo 2001	852 patients, 1 site	From controlled clinical trial, compared intervention and control groups in true cost-effectiveness analysis.	Detailed formal cost-effectiveness analysis, accounting for all costs of intervention. Overall hospital cost savings of $1661–3779 per hospitalization.
Rubin 2011	27,196 patients, 107 volunteers, 1 site	Historical controlled analysis done in a large quality improvement study.	Financial return of the program was estimated at > $7.3 million per year (from delirium prevention, shorter length of stay, and revenue generated from freeing up hospital beds).
Rubin 2017	7628 patients, 1 site	Historical controlled analysis done in a large quality improvement study.	HELP lowers risk for 30-day hospital readmission (adjusted relative risk 0.83, 95% CI 0.73–0.94). This translates to 100 fewer readmissions due to HELP during the one year study period. A 2% reduction in the Medicare readmission rate would mean 40,000 fewer readmissions nationally per year, or cost savings of approximately $491 million per year.
Zaubler 2013	595 patients, 1 site	Historical controlled analysis done in a quality improvement project. HELP adapted to a community hospital results in cost savings when variable costs were compared between patients and potential increased revenue calculated based on shorter lengths of stay for intervention patients.	Interventions resulted in $841,000 cost savings over 9 months for the hospital.

Note: All cost figures in 2018 US Dollars