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Table 12-71Home-based multidisciplinary early supported discharge vs. usual care - Economic summary of findings

StudyIncremental cost (£)Incremental effectsICERUncertainty
Hollingworth 1993-£722LOS; readmissions (l)N/AOne way sensitivity analysis: costs of MDR scheme at home would still be lower than usual care if inpatients costs 50% lower and MDR at home costs 50% higher than predicted.
O'Cathain 1994-£370Several outcomes reported (m)N/AN/R
Parker 1991-£799.80(n)Several outcomes reported (o)N/AN/R
NCGC economic model£434.6(p)0.0456 QALYs(q)£9533/QALYs95% CI: Community MDR dominant –usual care dominant (r)
l

LOS for MDR at home vs. usual care: 32.5 vs. 41.7 days (p<0.001); readmission rates at 1 year: 6.8% (53 patients) vs. 2.7% (8 patients), p=0.008

m

Several outcomes were reported: HRQoL measured with the Nottingham Health Profile questionnaire (14 vs. 24, p<0.05); Mortality (5.3% vs. 5.9%; p = NR); readmission rates at 3 months: (15.8% vs. 8.8%, p=0.187); LOS (median no of days): 10 vs. 17, p<0.001

n

Costs based on the following resource use: hospital length of stay; sessions with hospital occupational therapist; readmission days; MDR ESD staff time; other NHS or social services (GP visits, day care, meals on wheels, community services)

o

LOS (mean, days): 29 vs. 38 (p value: 0.035). Mortality (at 90 days): 40 (14%) vs. 14 (11%)

p

The mean costs associated with community MDR were estimated to be £6901.20 and for usual care £6466.60

q

The mean effectiveness corresponded to 3.1283 QALYs and 3.0827 QALYs for usual care.

r

Deterministic sensitivity analysis showed that findings were sensitive to the length of stay spent in hospital and during rehabilitation at home. Community MDR was found to be the most cost-effective option in 50% of the 10,000 simulations run in the PSA at a willingness to pay of £20k, and in 60% of the simulations at a willingness to pay of 30k per QALY.

LOS for MDR at home vs. usual care: 32.5 vs. 41.7 days (p<0.001); readmission rates at 1 year: 6.8% (53 patients) vs. 2.7% (8 patients), p=0.008

Several outcomes were reported: HRQoL measured with the Nottingham Health Profile questionnaire (14 vs. 24, p<0.05); Mortality (5.3% vs. 5.9%; p = NR); readmission rates at 3 months: (15.8% vs. 8.8%, p=0.187); LOS (median no of days): 10 vs. 17, p<0.001

Costs based on the following resource use: hospital length of stay; sessions with hospital occupational therapist; readmission days; MDR ESD staff time; other NHS or social services (GP visits, day care, meals on wheels, community services)

LOS (mean, days): 29 vs. 38 (p value: 0.035). Mortality (at 90 days): 40 (14%) vs. 14 (11%)

The mean costs associated with community MDR were estimated to be £6901.20 and for usual care £6466.60

The mean effectiveness corresponded to 3.1283 QALYs and 3.0827 QALYs for usual care.

Deterministic sensitivity analysis showed that findings were sensitive to the length of stay spent in hospital and during rehabilitation at home. Community MDR was found to be the most cost-effective option in 50% of the 10,000 simulations run in the PSA at a willingness to pay of £20k, and in 60% of the simulations at a willingness to pay of 30k per QALY.

From: 12, Multidisciplinary management

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NICE Clinical Guidelines, No. 124.
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