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Age and Ageing Advance Access published online on May 30, 2008
Age and Ageing, doi:10.1093/ageing/afn120
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Copyright © The Author 2008. Published by Oxford University Press on behalf of the British Geriatrics Society.

Post-acute care for older people in community hospitals—a cost-effectiveness analysis within a multi-centre randomised controlled trial

Jacqueline O'reilly1, Karin Lowson2, John Green3, John B. Young3 and Anne Forster3

1 Health Research and Information Division, Economic and Social Research Institute, Dublin, Ireland
2 York Health Economics Consortium Ltd., University of York, York, UK
3 Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, UK

Address correspondence to: J. B. Young. Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, UK. Tel: +44 (0)1274 383406; Fax: +44 (0)1274 382766. Email: john.young{at}bradfordhospitals.nhs.uk

Objectives: to compare the cost effectiveness of post-acute care for older people provided in community hospitals with general hospital care.

Design: cost-effectiveness study embedded within a randomised controlled trial.

Setting: seven community hospitals and five general hospitals at five centres in the midlands and north of England.

Participants: 490 patients needing rehabilitation following hospital admission with an acute illness.

Intervention: multidisciplinary team care for older people in community hospitals.

Measurements: EuroQol EQ-5D scores transformed into quality-adjusted life years; health and social service costs during the 6-month period following randomisation.

Results: there was a non-significant difference between the community hospital and general hospital groups for changes in quality-adjusted life-year values from baseline to 6 months (mean difference 0.048; 95% confidence interval –0.028 to 0.123; P = 0.214). Resource use was similar for both groups. The mean (standard deviation) costs per patient for health and social services resources used were comparable for both groups: community hospital group £8,946 (£6,514); general hospital group £8,226 (£7,453). These findings were robust to sensitivity analyses. The incremental cost-effectiveness ratio estimate was £16,324 per quality-adjusted life year. A cost effectiveness acceptability curve suggests that if decision makers' willingness to pay per quality-adjusted life year was £10,000, then community hospital care was effective in 47% of cases, and this increased to only 50% if the threshold willingness to pay was raised to £30,000.

Conclusions: the cost effectiveness of post-acute rehabilitation for older people was similar in community hospitals and general hospitals.

Keywords: health services for the aged, sub-acute care, convalescent hospitals, costs and cost analysis, aged 80 and over, elderly

Received 3 October 2007; accepted in revised form 18 April 2008.


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