OBJECTIVES

: Older people with unmet medical and social needs in the community could lead to avoidable hospital services utilization resulting in high healthcare cost. This study aimed to evaluate the cost-effectiveness of a person-centered home-health intervention, the Ageing-in-Place (AIP) programme among frequent admitters from a public hospital in northern Singapore.

METHODS

: A cost-effectiveness analysis (CEA) was performed to compare patients who received the AIP intervention (n=249) and controls (n=56) who received usual care for a prospective cohort of patients discharged between February and December 2014. Eligible participants needed to have been hospitalized at least 3 times during the 6-month prior to enrollment. Data were collected from hospital database and 6-monthly telephone surveys. CEA was assessed by cost per quality-adjusted life-years (QALYs). The bootstrapping method was employed to test uncertainty.

RESULTS

: Compared to the control group ($11,814, 0.156 QALYs), intervention group came at a greater cost and effectiveness ($13,985, 0.183 QALYs) with an incremental cost-effectiveness ratio (ICER) of $79,611, which is above the threshold value of $73,000 per QALY for Singapore. The bootstrapping analysis showed that AIP was cost-effective in about 50% of the simulations. Caregivers for AIP patients reported 2.5 fewer work days missed due to caregiving responsibilities. However, the associated cost with this was unknown.

CONCLUSIONS

: The AIP resulted in marginal increase in QALYs beyond the control group and was deemed, at best, on the high side of an acceptably cost-effective strategy. However, the high non-response rate precluded more accurate estimates of costs and effectiveness. Future improvements in the CEA should include additional measures of societal-level impacts such as patients’ productivity loss and caregivers’ quality of life. Future modest improvements in the effectiveness in the AIP program and/or modest decrements program costs would lead to an intervention that represents a good societal value.