The Impact of an Oncology Hospital at Home Program on Health Care Costs.

Abstract

Introduction: Hospital-at-home is an initiative to move health care services that have traditionally been provided in a hospital setting to a patient's home. The objective of this study was to assess the impact of the oncology Huntsman at Home (HH) hospital-at-home program on health care costs from the health care system's perspective.

Methods: Using a difference-in-difference approach, we compared health care costs between 169 oncology patients enrolled in HH and 198 similar patients who would have been eligible for HH but lived outside the HH service area. Costs were measured from the health system perspective using an innovative cost-accounting tool. We constructed longitudinal datasets spanning the 2 patient-quarters before enrollment and the 2 patient-quarters following an acute episode. Outcomes were total direct medical costs of health care encounters as well as subcategories of cost, including facility, imaging, supplies, pharmacy, labs, and other. We ran fixed effects linear regression models to assess the impact of HH on health care cost outcomes.

Results: We found that HH was associated with a statistically significant reduction in cost for the 6 months post-admission (total -$8,337, P =0.012) and the first quarter post-admission (-$10,516, P =0.009), with significant reductions in pharmacy, facility, and other costs. We also examined a subset of patients with gastrointestinal or gynecologic cancers as exemplars of patients at considerable risk for extended complications and found similar cost reductions 6 months (-$8006, P =0.006) and in the first quarter (-$10,438, P =0.004).

Conclusion: We found that an oncology hospital at home lowers health care costs, particularly during the 3 months following a care episode.