Background hospital level healthcare in the home guided by comprehensive geriatric assessment (CGA) might provide a less costly alternative to hospitalisation for older people. Objective to determine the cost-effectiveness of CGA admission avoidance hospital at home (HAH) compared with hospital admission. Design/intervention a cost-effectiveness study alongside a randomised trial of CGA in an admission avoidance HAH setting, compared with admission to hospital. Participants/setting older people considered for a hospital admission in nine locations across the UK were randomised using a 2:1 randomisation schedule to admission avoidance HAH with CGA (N = 700), or admission to hospital with CGA when available (N = 355). Measurements quality adjusted life years, resource use and costs at baseline and 6 months; incremental cost-effectiveness ratios were calculated. The main analysis used complete cases. Results adjusting for baseline covariates, HAH was less costly than admission to hospital from a health and social care perspective (mean −£2,265, 95% CI: −4,279 to −252), and remained less costly with the addition of informal care costs (mean difference −£2,840, 95% CI: −5,495 to −185). There was no difference in quality adjusted survival. Using multiple imputation for missing data, the mean difference in health and social care costs widened to −£2,458 (95% CI: −4,977 to 61) and societal costs remained significantly lower (−£3,083, 95% CI: −5,880 to −287). There was little change to quality adjusted survival. Conclusions CGA HAH is a cost-effective alternative to admission to hospital for selected older people.

中文翻译：

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对于老年人来说，在家医院进行综合老年评估是否是比住院更经济有效的替代方案？

以综合老年评估 (CGA) 为指导的背景医院级家庭医疗保健可能为老年人提供一种成本更低的住院治疗替代方案。目的是确定与住院相比，CGA 避免入院住院 (HAH) 的成本效益。设计/干预一项成本效益研究，同时在避免入院 HAH 环境中进行 CGA 随机试验，与入院进行比较。在英国九个地点考虑入院的参与者/环境老年人使用 2:1 随机化时间表进行随机分配，以通过 CGA 避免入院 HAH (N = 700)，或在可用时通过 CGA 入院 (N = 355) 。测量质量调整生命年、基线和 6 个月的资源使用和成本；计算了增量成本效益比。主要分析采用了完整的案例。对基线协变量进行调整后的结果，从健康和社会护理的角度来看，HAH 的费用低于入院费用（平均值 - 2,265 英镑，95% CI： -4,279 至 -252），并且在加上非正式护理费用后，费用仍然较低（平均差−2,840英镑，95% CI：−5,495至−185）。质量调整生存率没有差异。使用缺失数据的多重插补，健康和社会护理成本的平均差异扩大至−2,458英镑（95% CI：−4,977至61），而社会成本仍然显着较低（−3,083英镑，95% CI：−5,880至− 287）。质量调整生存率几乎没有变化。结论 对于特定老年人来说，CGA HAH 是一种经济高效的住院替代方案。