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BackgroundMany advantages of hospital at home (HaH), as a modality of acute care, have been highlighted, but controversies exist regarding the cost-benefit trade-offs.ObjectiveTo assess health outcomes and analytical costs of hospital avoidance (HaH-HA) in a consolidated service with over ten years of delivery of HaH in Barcelona (Spain).MethodsA retrospective cost-consequence analysis of all first episodes of HaH-HA, directly admitted from the emergency room (ER) in 2017–2018, was carried out. HaH-HA was compared with a propensity-score-matched group of contemporary patients admitted to conventional hospitalization (Controls). Mortality, re-admissions, ER visits, and direct healthcare costs were evaluated.RegistrationClinicalTrials.gov(26/04/2017;NCT03130283).ResultsHaH-HA and Controls (n=441 each) were comparable in terms of age (73 [SD16]vs74 [16]), gender (male, 57%vs59%), multimorbidity, healthcare expenditure during the previous year, case mix index of the acute episode, and main diagnosis at discharge. HaH-HA presented lower mortality during the episode (0 vs. 19 (4.3%);p< 0.001). At 30 days post-discharge, HaH-HA and Controls showed similar re-admission rates; however, ER visits were lower in HaH-HA than in Controls (28 (6.3%) vs 34 (8.1%); p = 0.044). Average costs per patient during the episode were lower in the HaH-HA group (€ 1,078) than in Controls (€ 2,171). Likewise, healthcare costs within the 30 days post-discharge were also lower in HaH-Ha than in Controls (p< 0.001).ConclusionsThe study showed higher performance and cost reductions of HaH-HA in a real-world setting. The identification of sources of savings facilitates scaling of hospital avoidance.FundingThis article was funded by JADECARE project- HP-JA-2019 - Grant Agreement nº951442 (2020-2023), a European Union’s Health Program 2014-2020.KEY POINTSHospital at home, modality hospital avoidance, shows high potential for value generation in real-world settings by improving health outcomes and generating cost-savings.Positive outcomes of hospital avoidance seem associated to adequate management change and digital support.