The cost-effectiveness of specialist hospital discharge and intermediate care services for patients who are homeless

Abstract Objective To evaluate the cost-effectiveness of specialist hospital discharge and intermediate care (support after discharge) services for people who are homeless in England. Methods We estimated the comparative cost and consequences of different types of specialist care provided by 17 homeless hospital discharge and intermediate care services. We compared ‘clinically-led’ (multidisciplinary) services with those that were ‘housing-led’ (uniprofessional). We also compared schemes that provided access to ‘step-down’ intermediate care with those that did not. We examined the variation in the effect of different types of schemes compared with a standard care control. Use of resource data for specialist care were sourced through linkage with HES. A control group from a published trial was used as a proxy for standard care. The measure of effectiveness was the number of bed days avoided (in terms of hospital stays for all readmissions in the follow-up period) per homeless user. Additional in-depth analysis of three configurations looked at quality-adjusted life years (QALYs) and service delivery costs. The perspective adopted was NHS in England. Results Specialist homeless hospital discharge (HHD) care is more cost-effective than standard care. Patients accessing specialist care use fewer bed days per year (including both planned and unplanned readmissions) and presented better QALY outcome. Patients using specialist care have more planned readmissions to hospital and, overall, use more NHS resources than those who use standard care. We interpret this as a positive outcome indicating that specialist care is working more effectively than standard care to improve access to healthcare for this marginalised group. The model remained cost-effective over a range of sensitivity analyses. Conclusion Specialist HHD services are likely to be cost-effective for the NHS compared with standard care.