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Health economic studies on advanced home care
Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to examine the cost-effectiveness of specific advanced home care and home rehabilitation interventions and to improve economic evaluation methods when applied to advanced home care. This included a comparison of two alternative ways of administering oxygen at home to patients with chronic hypoxaemia, as well as a review of scientific evidence on costs and effects of home rehabilitation after stroke. Also included were studies on prominent methodological issues in advanced home care - the redistribution of care efforts among caregivers and costing of informal care efforts.

For patients with chronic hypoxaemia, a randomised, controlled trial showed that mobile liquid oxygen was considerably more costly compared to concentrator treatment. However, the treatment effects showed that liquid oxygen had a better impact on patient quality of life. The literature review revealed that the outcomes and costs of home rehabilitation after stroke are equal to those of alternative treatment strategies. Similar results were obtained in a study comparing hospital-based and home-based stroke rehabilitation, which also showed that there is a considerable redistribution of costs between health care providers and social welfare providers. Studies of patients in advanced home care in the county of Östergötland, Sweden, showed that the cost of informal care constitutes a considerable part of the care effort in all costing approaches used. Also, informal care costs were higher among patients who were men, who were younger, who had their own housing and had a cancer diagnosis.

This thesis reveals that advanced home care interventions can differ regarding costs as well as effects, and thus comparisons between alternative home care interventions must also be performed. Further, redistribution effects are important to consider in evaluations. The cost of informal care is substantial in advanced home care. These costs must be included in evaluations with a societal perspective or else the comparisons will be biased.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2002. , 66 p.
Series
Linköping Dissertations on Health and Society, ISSN 1651-1646 ; 2
Keyword [en]
health economics, economic evaluation, advanced home care, redistribution, cost, informal care
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:liu:diva-5405ISBN: 91-7373-445-4 (print)OAI: oai:DiVA.org:liu-5405DiVA: diva2:21301
Public defence
2002-11-22, Aulan, Hus 240, Campus US, Linköpings universitet, Linköping, 10:00 (English)
Available from: 2002-12-19 Created: 2002-12-19 Last updated: 2012-01-25Bibliographically approved
List of papers
1. Domiciliary liquid oxygen versus concentrator treatment in chronic hypoxaemia: a cost-utility analysis
Open this publication in new window or tab >>Domiciliary liquid oxygen versus concentrator treatment in chronic hypoxaemia: a cost-utility analysis
Show others...
1998 (English)In: European Respiratory Journal, ISSN 1399-3003, Vol. 12, no 6, 1284-1289 p.Article in journal (Refereed) Published
Abstract [en]

Whether long-term oxygen therapy (LTOT) improves quality of life in chronic hypoxaemia has been questioned. LTOT with an oxygen concentrator (C/C) and gas cylinders for ambulation is considered cumbersome compared to mobile liquid oxygen equipment (L). The hypothesis for this study was that LTOT with liquid oxygen treatment (L) improves patients' health-related quality of life, but that it is also more expensive compared to concentrator (C/C) treatment. A prospective, randomized multicentre trial comparing C/C with L for LTOT was conducted during a six-month period. Fifty-one patients (29 on L and 22 on C/C) with chronic hypoxaemia, regularly active outside the home, participated in the study initially. Costs for oxygen were obtained from the pharmacies. Patient diaries and telephone contacts with members of the healthcare sector were used to estimate costs. Health-related quality of life was measured by the Sickness Impact Profile (SIP) and the EuroQol, instruments at the start and after 6 months. The average total cost per patient for group C/C for the six-month period was US$1,310, and for group L it was US$4,950. Health-related quality of life measured by the SIP instrument showed significant differences in favour of group L in the categories/dimensions of physical function, body care, ambulation, social interaction and total SIP score. In conclusion, liquid-oxygen treatment was more expensive compared to concentrator treatment. However, treatment effects showed that liquid oxygen had a better impact on quality of life.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13751 (URN)
Available from: 2002-12-19 Created: 2002-12-19
2. Home rehabilitation after stroke. Reviewing the scientific evidence on effects and costs
Open this publication in new window or tab >>Home rehabilitation after stroke. Reviewing the scientific evidence on effects and costs
2000 (English)In: International Journal of Technology Assessment in Health Care,, ISSN 0266-4623, Vol. 19, no 3, 842-848 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The question addressed here is whether home rehabilitation after stroke is better and/or less expensive than the more conventional alternatives, i.e., rehabilitation during inpatient care, day care, and outpatient visits--alone or in combinations appropriate to disease stage and patient needs. Home rehabilitation is managed by teams of professionals who train patients at home. METHODS: The scientific literature was systematically searched for controlled studies comparing outcomes and costs of home rehabilitation with the more conventional strategies. RESULTS: The abstracts of 204 papers were evaluated, from which 89 were selected for greater scrutiny. From the 89 studies, we found 7 controlled studies involving 1,487 patients (6 of the 7 were randomized, 4 of the 6 assessed costs). No statistically significant differences, or tendencies toward differences, were revealed as regards the outcome of home rehabilitation versus hospital-based alternatives. Thus, home rehabilitation was neither better nor worse at improving patients' ability to manage on their own or resume social activities. Depression and reduced quality of life were common in all groups of patients and caregivers, irrespective of the rehabilitation strategy. In the four randomized studies that reported on costs, home rehabilitation was found to be less expensive than regular day care, but not less expensive than conventional strategies even though hospital stay was reduced. CONCLUSION: The outcomes and costs of home rehabilitation after stroke seem to be comparable to alternative treatment strategies.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13752 (URN)
Available from: 2002-12-19 Created: 2002-12-19
3. Health care and social welfare costs in home-based and hospital-based rehabilitation after stroke
Open this publication in new window or tab >>Health care and social welfare costs in home-based and hospital-based rehabilitation after stroke
2002 (English)In: Scandinavian Journal of Caring Sciences, Vol. 16, no 4, 386-392 p.Article in journal (Refereed) Published
Abstract [en]

During the 1990s most western European and Organization of Economic Cooperation and Development (OECD) countries experienced financial difficulties and were forced to cut back on or restrain health care expenditures. Home rehabilitation has received attention in recent years because of its potential for cost containment. Often forgotten, however, is the redistribution of costs from one caregiver to another. The aim of this study was to analyse whether a redistribution of costs occurs between health care providers (the County councils) and social welfare providers (the municipalities) in a comparison of home-based rehabilitation and hospital-based rehabilitation after stroke. The study population included 123 patients, 53 in the home-based rehabilitation group and 68 in the hospital-based rehabilitation group. The patients were followed up at 6 and 12 months after onset of stroke. Resource use over a 12-month period included acute hospital care, in-hospital rehabilitation, home rehabilitation and use of home-help service as well as nursing home living. The hospital-based rehabilitation group had significantly fewer hospitalization days after a decision was made about rehabilitation at the acute care ward and consequently the cost for the acute care period was significantly lower. The cost for the rehabilitation period was significantly lower in the home-based rehabilitation group. However, the cost for home help service was significantly higher in the home-based rehabilitation group. The total costs for the care episode did not differ between the two groups. The main finding of this study is that there seems to occur a redistribution of costs between health care providers and social welfare providers in home rehabilitation after stroke in a group of patients with mixed degree of impairment.

Keyword
home-based rehabilitation, hospital-based rehabilitation, redistribution of cost, stroke, cost
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13753 (URN)10.1046/j.1471-6712.2002.00115.x (DOI)
Available from: 2002-12-19 Created: 2002-12-19 Last updated: 2009-10-31
4. The economic burden of informal care
Open this publication in new window or tab >>The economic burden of informal care
2002 (English)In: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, Vol. 18, no 1, 46-54 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The great interest focused on home care technologies during the last decade resulted from its potential to cut costs. However, the reallocation of costs between healthcare providers and social welfare providers, and the indirect costs of informal care, are not as frequent topics of discussion. The aim of this paper is to discuss different models for estimating the costs of informal care in the home care setting in economic appraisals. METHODS: The outcome of using different models for estimating indirect costs was illustrated using empirical data regarding the time spent by informal caregivers in providing care in a group of home care patients (n = 59). The models used comprise different interpretations of the traditional human capital approach and the friction cost model. RESULTS AND CONCLUSIONS: Informal care is an important component in home care. The inclusion of indirect costs of informal care in economic appraisals will have implications for the cost-effectiveness of home care, since it will raise costs depending on the model used for estimating indirect costs. In this study we have shown that indirect costs estimated by the friction cost model only amount to 18% to 44% of the cost when the human capital approach is used. The results indicate that, regardless of the method used to estimate indirect costs, the cost of informal care in evaluations of home care programs is often underestimated due to the exclusion of indirect costs.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13754 (URN)
Available from: 2002-12-19 Created: 2002-12-19
5. Costs of informal care for patients in advanced home care: a population based study
Open this publication in new window or tab >>Costs of informal care for patients in advanced home care: a population based study
2003 (English)In: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 19, no 4, 656-663 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: Several studies have sought to analyze the cost-effectiveness of advanced home care andhome rehabilitation. However, the costs of informal care are rarely included in economic appraisals ofhome care. This study estimates the cost of informal care for patients treated in advanced home careand analyses some patient characteristics that influence informal care costs.Methods: During one week in October 1995, data were collected on all 451 patients in advanced homecare in the Swedish county of O¨ stergo¨ tland. Costs were calculated by using two models: one includingleisure time, and one excluding leisure time. Multiple regression analysis was used to analyze factorsassociated with costs of informal care.Results: Seventy percent of the patients in the study had informal care around the clock during theweek investigated. The patients had, on average, five formal care visits per week, each of which lastedfor almost half an hour. Thus, the cost of informal care constituted a considerable part of the costof advanced home care. When the cost of leisure time was included, the cost of informal care wasestimated at SEK 5,880 per week per patient, or twice as high as total formal caregiver costs. Whenleisure time was excluded, the cost of informal care was estimated at SEK 3,410 per week per patient,which is still 1.2 times higher than formal caregiver costs (estimated at SEK 2,810 per week per patient).Informal care costs were higher among patients who were men, who were younger, who had their ownhousing, and who were diagnosed with cancer.Conclusions: Studies of advanced home care that exclude the cost of informal care substantiallyunderestimate the costs to society, regardless of whether or not the leisure time of the caregiver isincluded in the calculations.

Keyword
Informal care, Advanced home care, Home rehabilitation, Cost
National Category
Public Administration Studies Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-13755 (URN)10.1017/S0266462303000618 (DOI)
Available from: 2002-12-19 Created: 2002-12-19 Last updated: 2017-01-03Bibliographically approved

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