Home-based geriatric rehabilitation after shortened inpatient rehabilitation: cost-effectiveness analysis of the "Better@Home" multicentre prospective cohort study with a matched historical control group.

Abstract

Purpose: Geriatric rehabilitation (GR) is facing increased demand due to population ageing. Home-based GR could reduce reliance on resource-intensive inpatient care. However, evidence is limited regarding the cost-effectiveness of home-based GR. The aim of this study is to assess the cost-effectiveness of home-based GR following shortened inpatient GR, compared to conventional inpatient GR.

Methods: Eight GR facilities in the Netherlands implemented the Better@Home program, in which home-based GR following shortened inpatient GR is compared to a historical control group receiving conventional inpatient GR. The effect measure was independence in activities of daily living (ADL), assessed by the Barthel Index (BI). Costs were measured as healthcare and societal resource use. Data was gathered at GR-admission- and GR-discharge through semi-structured interviews, registration forms, and electronic patient files. Costs and effects were analyzed using linear mixed effects (LMM) and generalised linear (GLM) regression models, combined with multiple imputation and non-parametric bootstrapping. The primary analysis was conducted from a healthcare perspective valued using national unit sources.

Results: A total of 350 participants were included (intervention n = 110; control n = 240). The adjusted incremental effect was 0.44 BI-points (95% CI - 0.44 to 1.31), and incremental costs of - €722,63 (95% CI - €2.693,68 to €1.248,43). Uncertainty assessments using non-parametric bootstrapping demonstrated an average mean incremental effect of 0.44 BI-points (95% CI 0.27 to 0.61) and incremental costs of - €654,72 (95% CI - €1.035,66 to - €267,48), indicating a probabilistic pattern favouring the Better@Home program.

Conclusions: The Better@Home program achieved levels of independence in ADL comparable to conventional inpatient GR while showing lower mean costs, suggesting that the program may be cost-effective.