1. Cost-minimisation analysis of home care reablement for older people in England: A modelling study
- Author
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Cate Henderson, Martin Knapp, Raphael Wittenberg, José-Luis Fernández, and Annette Bauer
- Subjects
Gerontology ,Male ,Sociology and Political Science ,Social Welfare ,Home Care Services, Hospital-Based ,Minimisation (clinical trials) ,State Medicine ,03 medical and health sciences ,0302 clinical medicine ,Cost of Illness ,Health care ,Medicine ,Humans ,030212 general & internal medicine ,Aged ,Aged, 80 and over ,business.industry ,030503 health policy & services ,Health Policy ,Public Health, Environmental and Occupational Health ,Univariate ,Uncertainty ,Length of Stay ,Home Care Services ,Confidence interval ,Hospitalization ,England ,Economic evaluation ,Community health ,Costs and Cost Analysis ,Female ,0305 other medical science ,business ,Social Sciences (miscellaneous) ,Independent living - Abstract
Many governments have introduced or encouraged home-care reablement schemes for older people at home with the aim of improving outcomes and reducing costs. We examined if such schemes have the potential to reduce costs from the perspective of the National Health Service (NHS) and Personal Social Services (PSS) in England. Our study was carried out to inform recommendations of a national guideline. Cost-minimisation analysis was carried out using decision-analytic Markov modelling. Home-care reablement was compared with standard home care. Costs included those of the intervention, home care and hospital admission. Uncertainty was explored using univariate and probabilistic sensitivity analysis. Mean costs per person were £56,499 (95% confidence interval 55,690 to 57,307) in the reablement group, and £58,560 (95% confidence interval 57,800 to 59,319) in the standard care group. The mean difference was -£2,061 (95% confidence interval 1,933 to 2,129). The probability that home-care reablement costs less than standard home care was 94.5% (95% confidence interval 93.1 to 95.9). In sensitivity analyses, this probability remained above 85% in all scenarios. Home-care reablement can be a successful cost-minimisation strategy for supporting some older people. More research is needed about the impact of home-care reablement on health outcomes for different groups of older people; and the effects of different durations of reablement on outcomes and costs for different subpopulations.
- Published
- 2018