| Summary: | <p><strong>Background</strong></p>
hospital level healthcare in the home guided by comprehensive geriatric assessment (CGA) might provide a less costly alternative to hospitalisation for older people.
<p><strong>Objective</strong></p>
to determine the cost-effectiveness of CGA admission avoidance hospital at home (HAH) compared with hospital admission.
<p><strong>Design/intervention</strong></p>
a cost-effectiveness study alongside a randomised trial of CGA in an admission avoidance HAH setting, compared with admission to hospital.
<p><strong>Participants/setting</strong></p>
older people considered for a hospital admission in nine locations across the UK were randomised using a 2:1 randomisation schedule to admission avoidance HAH with CGA (N = 700), or admission to hospital with CGA when available (N = 355).
<p><strong>Measurements</strong></p>
quality adjusted life years, resource use and costs at baseline and 6 months; incremental cost-effectiveness ratios were calculated. The main analysis used complete cases.
<p><strong>Results</strong></p>
adjusting for baseline covariates, HAH was less costly than admission to hospital from a health and social care perspective (mean −£2,265, 95% CI: −4,279 to −252), and remained less costly with the addition of informal care costs (mean difference −£2,840, 95% CI: −5,495 to −185). There was no difference in quality adjusted survival. Using multiple imputation for missing data, the mean difference in health and social care costs widened to −£2,458 (95% CI: −4,977 to 61) and societal costs remained significantly lower (−£3,083, 95% CI: −5,880 to −287). There was little change to quality adjusted survival.
<p><strong>Conclusions</strong></p>
CGA HAH is a cost-effective alternative to admission to hospital for selected older people.
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