A trial based economic evaluation of occupational therapy discharge planning for older adults: the HOME randomized trial

Kylie Wales, Glenn Salkeld, Lindy Clemson, Natasha A. Lannin, Laura Gitlin, Laurence Rubenstein, Kirsten Howard, Martin Howell, Ian D. Cameron

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8 Citations (Scopus)


Objective: To compare the cost effectiveness of two occupational therapy–led discharge planning interventions from the HOME trial. Design: An economic evaluation was conducted within the superiority randomized HOME trial to assess the difference in costs and health-related outcomes associated with the enhanced program and the in-hospital consultation. Total costs of health and community service utilization were used to calculate incremental cost-effectiveness ratios, activities of daily living and quality-adjusted life years. Setting: Medical and acute care wards of Australian hospitals (n=5). Subjects: A total of 400 people ≥ 70 years of age. Interventions: Participants were randomized to either (1) an enhanced program (HOME), involving pre/post discharge visits and two follow-up phone calls, or (2) an in-hospital consultation using the home and community environment assessment and the Lawton Instrumental Activities of Daily Living assessment. Main measures: Nottingham Extended Activities of Daily Living (global measure of activities of daily living) and SF-12V2, transformed into SF-6D (quality-adjusted life year) measured at baseline and three months post discharge. Results: The cost of the enhanced program was higher than that of the in-hospital consultation. However, a higher proportion of patients showed improvement in activities of daily living in the enhanced program with an incremental cost-effectiveness ratio of $61,906.00 per person with clinically meaningful improvement. Conclusion: Health services would not save money by implementing the enhanced program as a routine intervention in medical and acute care wards. Future research should incorporate longer time horizons and consider which patient groups would benefit from home visits.

Original languageEnglish
Pages (from-to)919-929
Number of pages11
JournalClinical Rehabilitation
Issue number7
Publication statusPublished - 1 Jul 2018
Externally publishedYes


  • economic evaluation
  • occupational therapy
  • Older adults

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