A trial based economic evaluation of occupational therapy discharge planning for older adults: the HOME randomized trial
Objective: To compare the cost effectiveness of two occupational therapy-led discharge planning interventions from the HOME trial. Design: An economic evaluation was conducted within the superiority randomized HOME trial to assess the difference in costs and health-related outcomes associated with the enhanced program and the in-hospital consultation. Total costs of health and community service utilization were used to calculate incremental cost-effectiveness ratios, activities of daily living and quality-adjusted life years. Setting: Medical and acute care wards of Australian hospitals (n=5). Subjects: A total of 400 people ≥ 70 years of age. Interventions: Participants were randomized to either (1) an enhanced program (HOME), involving pre/post discharge visits and two follow-up phone calls, or (2) an in-hospital consultation using the home and community environment assessment and the Lawton Instrumental Activities of Daily Living assessment. Main measures: Nottingham Extended Activities of Daily Living (global measure of activities of daily living) and SF-12V2, transformed into SF-6D (quality-adjusted life year) measured at baseline and three months post discharge. Results: The cost of the enhanced program was higher than that of the in-hospital consultation. However, a higher proportion of patients showed improvement in activities of daily living in the enhanced program with an incremental cost-effectiveness ratio of $61,906.00 per person with clinically meaningful improvement. Conclusion: Health services would not save money by implementing the enhanced program as a routine intervention in medical and acute care wards. Future research should incorporate longer time horizons and consider which patient groups would benefit from home visits.
Wales, K., Salkeld, G., Clemson, L., Lannin, N. A., Gitlin, L., Rubenstein, L., Howard, K., Howell, M. & Cameron, I. D. (2018). A trial based economic evaluation of occupational therapy discharge planning for older adults: the HOME randomized trial. Clinical Rehabilitation, 32 (7), 919-929.