An economic evaluation of pre-discharge home assessment visits following hip fracture: Analysis from a randomised controlled trial

Objective: To investigate cost-effectiveness of pre-discharge home assessment visits for patients recovering after hip fracture. Design: Cost-effectiveness analysis completed alongside a randomised controlled trial. Setting: Hospital wards and the community. Participants: Adults 50 years and over with hip fractures planning to return home. Intervention: Participants were randomised to either usual-care hospital-based discharge planning or usual-care hospital-based discharge planning with a pre-discharge home assessment visit by an occupational therapist. Main measures: Functional Independence Measure, EQ-5D-3L, and number of falls. Incremental cost-effectiveness ratios were calculated for changes at 30 days and 6 months. Results: Seventy-seven patients participated. Compared to usual care, the home assessment group likely had fewer falls at 30 days (incidence rate ratio = 0.41, 95% confidence interval (CI) 0.15 to 1.11) and increased functional independence at 6 months (11.2 units, 95% CI 4.2 to 18.2) but no difference in quality of life (0.0 units, 95% CI −0.1 to 0.1). The mean cost to provide a home assessment visit was A$135.70. A mean cost saving of A$6182 (95% CI −$6414 to $18,777) favoured the home assessment group. The incremental cost-effectiveness ratio found a saving of A$71,337 (95% CI −$998,930 to $411,409) in achieving clinically important changes in functional independence for the home assessment group at 6 months and a saving of A$34,832 (95% CI −$331,344 to $213,900) per fall avoided in favour of the home assessment group at 30 days. Conclusion: From a health service perspective, pre-discharge home assessments for patients after hip fracture are likely to be cost-effective in restoring functional independence and reducing falls.