Age and Ageing 2008; 37: 513–520
Published electronically 30 May 2008
The Author 2008. Published by Oxford University Press on behalf of the British Geriatrics Society.
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Post-acute care for older people in community
hospitals—a cost-effectiveness analysis within a
multi-centre randomised controlled trial
JACQUELINE O’REILLY1, KARIN LOWSON2, JOHN GREEN3, JOHN B. YOUNG3, ANNE FORSTER3
1Health Research and Information Division, Economic and Social Research Institute, Dublin, Ireland
2York Health Economics Consortium Ltd., University of York, York, UK
3Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, UK
Address correspondence to: J. B. Young. Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Royal
Infirmary, Duckworth Lane, Bradford BD9 6RJ, UK. Tel: +44 (0)1274 383406; Fax: +44 (0)1274 382766.
Objectives: to compare the cost effectiveness of post-acute care for older people provided in community hospitals with
general hospital care.
Design: cost-effectiveness study embedded within a randomised controlled trial.
Setting: seven community hospitals and five general hospitals at five centres in the midlands and north of England.
Participants: 490 patients needing rehabilitation following hospital admission with an acute illness.
Intervention: multidisciplinary team care for older people in community hospitals.
Measurements: EuroQol EQ-5D scores transformed into quality-adjusted life years; health and social service costs during
the 6-month period following randomisation.
Results: there was a non-significant difference between the community hospital and general hospital groups for changes in
quality-adjusted life-year values from baseline to 6 months (mean difference 0.048; 95% confidence interval −0.028 to 0.123;
P = 0.214). Resource use was similar for both groups. The mean (standard deviation) costs per patient for health and social
services resources used were comparable for both groups: community hospital group £8,946 (£6,514); general hospital group
£8,226 (£7,453). These findings were robust to sensitivity analyses. The incremental cost-effectiveness ratio estimate was
£16,324 per quality-adjusted life year. A cost effectiveness acceptability curve suggests that if decision makers’ willingness to
pay per quality-adjusted life year was £10,000, then community hospital care was effective in 47% of cases, and this increased
to only 50% if the threshold willingness to pay was raised to £30,000.
Conclusions: the cost effectiveness of post-acute rehabilitation for older people was similar in community hospitals and
Keywords: health services for the aged, sub-acute care, convalescent hospitals, costs and cost analysis, aged 80 and over, elderly
Community hospitals are an existing, well established
form of health care, widely available across the United
Kingdom with the potential to provide intermediate care
services for older people . However, the evidence base
for their clinical and economic impact is not robust .
Purchasers should be reluctant to commit funds to
services where effectiveness and cost effectiveness have
not been demonstrated, particularly where investments such
as community hospitals or other intermediate care facilities
may be significant.
We reporton an economic evaluationthat was embedded
within a randomised controlled trial of community hospital
care for older people. Following an acute admission,
medically stable patients were randomised to transfer to
a community hospital or to remain in the general hospital
for rehabilitation. The study took place within five centres
in the midlands and north of England. A previous report
has described the study patients, sites and trial methods .
The main clinical outcome result was a clinically modest
but statistically significant difference in independence at
6 months for patients randomised to community hospital
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Received 3 October 2007; accepted in revised form 18 April 2008
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