Cost analysis of admitting nursing home residents to hospital at home: A Danish micro-costing approach

OBJECTIVES: Hospital at Home (HaH) is a new care concept aimed at reducing hospital admissions by providing specialised healthcare to patients at home. The aim of this study was to compare the cost of a HaH model with traditional hospital admission for nursing home residents with acute illness in the Northern Region of Denmark.

STUDY DESIGN: This study employed a retrospective micro-costing approach based on initial findings from the early implementation of the HaH model. The analysis was conducted from a healthcare sector perspective.

METHODS: A comprehensive framework for cost analysis was developed based on policy documents, clinical guidelines, and interviews with administrative and leading healthcare professionals. Data on resource usage was obtained from clinical experts and case notes. Costs for resource usage were valued using payroll data for different job categories and Danish DRG-tariffs. The estimated costs of care models were compared and deterministic sensitivity analysis identified important factors for the cost difference.

RESULTS: The analysis showed that the HaH model is associated with cost savings of 40-45 % compared to traditional hospital admissions. Furthermore, the sensitivity analysis indicate that it is crucial to consider the extent of additional time healthcare professionals allocate to extra care, when a nursing home resident is admitted at home, as this parameter significantly influences the costs associated with HaH.

CONCLUSIONS: Based on the costing framework, we found that the HaH model was cheaper than traditional hospitalisations. These results were robust to variations in resource use of different activities in the HaH model.