Cost analysis of hospital-at-home services vs. in-patient medical wards

Abstract Objective: Hospital-at-home schemes have been widely adopted as an alternative to in-hospital treatment for acutely ill patients. However, their impact on hospital costs remains unclear. Study setting: we calculated the costs during the index admission and 30 days later of 131 randomly selected acutely ill patients attending a tertiary medical center in 2011-2021 who met the inclusion criteria for hospital-at-home care. study design: findings were compared to a simulation of the same cohort based on assumptions of potential costs and outcomes under a hospital-at-home program. principal findings: hospital-at-home care was found to incur higher costs during the index admission (+30%) and 30 days after (+14%). It remained costlier on most subpopulation and sensitivity analyses, except when patients were readmitted within 30 days of the index admission (-27%), owing to 30% lower hospital-at-home labor costs, and if the predicted index admission days were decreased by 10% in the hospital-at-home scheme (-11%). Conclusions: under the assumptions made, there may not be a clear and robust cost reduction to hospitals by the mere application of a hospital-at-home scheme.