TY - JOUR
T1 - Cost-Effectiveness of Early Assisted Discharge for COPD Exacerbations in The Netherlands
AU - Goossens, Lucas M. A.
AU - Utens, Cecile M. A.
AU - Smeenk, Frank W. J. M.
AU - van Schayck, Onno C. P.
AU - van Vliet, Monique
AU - van Litsenburg, Walter
AU - Braken, Maria W.
AU - Rutten-van Molken, Maureen P. M. H.
PY - 2013/6
Y1 - 2013/6
N2 - Objectives: Hospital admissions for exacerbations of chronic obstructive pulmonary disease are the main cost drivers of the disease. An alternative is to treat suitable patients at home instead of in the hospital. This article reports on the cost-effectiveness and cost-utility of early assisted discharge in The Netherlands. Methods: In the multicenter randomized controlled Assessment of GOing Home under Early Assisted Discharge trial (n = 139), one group received 7 days of inpatient hospital treatment (HOSP) and one group was discharged after 3 days and treated at home by community nurses for 4 days. Health care resource use, productivity losses, and informal care were recorded in cost questionnaires. Microcosting was performed for inpatient day costs. Results: Seven days after admission, mean change from baseline Clinical Chronic Obstructive Pulmonary Disease Questionnaire score was better for HOSP, but not statistically significantly: 0.29 (95% confidence interval [CI] -0.04 to 0.61). The difference in the probability of having a clinically relevant improvement was significant in favor of HOSP: 19.0%-point (95% CI 0.5%-36.3%). After 3 months of follow-up, differences in effectiveness had almost disappeared. The difference in quality-adjusted life-years was 0.0054 (95% CI -0.021 to 0.0095). From a health care perspective, early assisted discharge was cost saving: -(sic)244 (treatment phase, 95% CI -(sic)315 to -(sic)168) and -(sic)168 (3 months, 95% CI -(sic)1253 to 922). Societal perspective: -(sic)65 (treatment phase, 95% CI -(sic)152 to 25) and 908 (3 months, 95% CI -(sic)553 to 2296). The savings per quality-adjusted life-year lost were 31,111 from a health care perspective. From a societal perspective, HOSP was dominant. Conclusions: No clear evidence was found to conclude that either treatment was more effective or less costly.
AB - Objectives: Hospital admissions for exacerbations of chronic obstructive pulmonary disease are the main cost drivers of the disease. An alternative is to treat suitable patients at home instead of in the hospital. This article reports on the cost-effectiveness and cost-utility of early assisted discharge in The Netherlands. Methods: In the multicenter randomized controlled Assessment of GOing Home under Early Assisted Discharge trial (n = 139), one group received 7 days of inpatient hospital treatment (HOSP) and one group was discharged after 3 days and treated at home by community nurses for 4 days. Health care resource use, productivity losses, and informal care were recorded in cost questionnaires. Microcosting was performed for inpatient day costs. Results: Seven days after admission, mean change from baseline Clinical Chronic Obstructive Pulmonary Disease Questionnaire score was better for HOSP, but not statistically significantly: 0.29 (95% confidence interval [CI] -0.04 to 0.61). The difference in the probability of having a clinically relevant improvement was significant in favor of HOSP: 19.0%-point (95% CI 0.5%-36.3%). After 3 months of follow-up, differences in effectiveness had almost disappeared. The difference in quality-adjusted life-years was 0.0054 (95% CI -0.021 to 0.0095). From a health care perspective, early assisted discharge was cost saving: -(sic)244 (treatment phase, 95% CI -(sic)315 to -(sic)168) and -(sic)168 (3 months, 95% CI -(sic)1253 to 922). Societal perspective: -(sic)65 (treatment phase, 95% CI -(sic)152 to 25) and 908 (3 months, 95% CI -(sic)553 to 2296). The savings per quality-adjusted life-year lost were 31,111 from a health care perspective. From a societal perspective, HOSP was dominant. Conclusions: No clear evidence was found to conclude that either treatment was more effective or less costly.
KW - COPD exacerbations
KW - cost-effectiveness
KW - early assisted discharge
KW - hospital-at-home
U2 - 10.1016/j.jval.2013.01.010
DO - 10.1016/j.jval.2013.01.010
M3 - Article
C2 - 23796285
SN - 1098-3015
VL - 16
SP - 517
EP - 528
JO - Value in Health
JF - Value in Health
IS - 4
ER -