The effectiveness and cost-effectiveness of a virtual Hospital in the Home service for COVID-19 infection: A cohort study and modelled decision analysis.

Abstract

IntroductionThis paper estimates the effectiveness and cost-effectiveness of a Hospital in the Home (HITH) service using virtual care technology to provide home-based care for COVID-19 patients with moderate symptoms in Queensland, Australia.MethodsA cohort study was conducted to analyse data of all patients admitted to the virtual COVID-19 HITH service between December 2021 and November 2022. A decision tree model was developed to compare of the cost-effectiveness of this service with a hypothetical usual care cohort admitted to a conventional physical ward from the perspective of the Australian health system. Comparator cohort data were sourced from published literature. Base-case analysis employed a 3-month time horizon with an additional lifetime scenario analysis. Quality-adjusted life-years (QALYs) were used as the measure of effectiveness. Sensitivity analyses were performed to assess the robustness of the model.ResultsThe virtual COVID-19 HITH service saved 15,273 bed days. The cost-effectiveness analysis indicated the virtual COVID-19 HITH model was dominant, resulting in an additional 0.015 QALYs and a cost saving of $201 per patient compared to usual care. The incremental cost-effectiveness ratio was most sensitive to the cost of operating the virtual HITH. When all uncertainties were considered, there was 74% likelihood that the virtual HITH model of care was cost-effective, assuming a willingness to pay of $28,033/QALY.DiscussionHITH services incorporating virtual care modalities replicating the systems, staffing, and daily routines of a hospital ward are likely to be an effective and cost-effective intervention to expand inpatient care capacity.