Cancer treatment at home or in the hospital: what are the costs for French public health insurance?: Findings of a comprehensive-cancer centre
Introduction
The development of hospital at home services aims at improving patient's satisfaction and quality of life by offering the possibility of such care when desired [1], [2], [3], and at increasing healthcare efficiency [4], [5], [6].
In France, the impact of hospital at home care on health resources has been little studied, either in terms of healthcare production costs or expenses for payers.
The case of hospital at home for cancer treatment is interesting to study, as hospital at home schemes for this pathology are rapidly developing as a substitute for inpatient hospital care. Moreover, both forms of healthcare are 100% financed by one single payer: French public health insurance.
The work presented here was carried out at the Centre Léon Bérard (CLB), a comprehensive cancer centre in Lyon, France, where a Hospitalisation Alternatives Department (the “Department”) has been set up to manage hospital at home care for patients following hospitalisation at the CLB.
The objective of this study was to evaluate the impact of hospital at home services on French public health insurance as a payer. More precisely, our objective was to compare, from the payer's point of view, the cost of this type of patient management with the estimated cost of treating the same patients in a standard hospital setting.
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Patients and methods
A randomised study comparing health care costs for hospital at home and inpatient hospital care was not considered as an appropriate method for this study. Patients who have already received treatments both at home and at the hospital might have a strong preference for one of the two places and therefore refuse the randomisation process. In this case, there would have been a major risk of refusal of participation, leading to uncontrolled bias.
Consequently, observed costs (hospital at home) were
Patient characteristics
From January 15–28, 2001, 110 patients received hospital at home care. Of these 110 patients, 28 were excluded from the analysis, for even if hospital at home care had not been organised they would not have required hospitalisation during the study period. In effect, four patients did not receive any treatment during this period (control blood tests only), and the health state of 24 others would not have justified hospitalisation: 18 received traditional nursing care (bathing, dressings or
Observation period
The period chosen can be considered as representative of the Department's average activity, for it corresponded neither to school holiday periods nor to public holidays. The inclusion of all patients followed up by the Department enabled us to discover the proportion of the Department's activity that truly corresponds to alternatives, which enable patients to avoid hospitalisation in one form or another. Of the 110 patients included in the study, 86 fell into this category, representing almost
Conclusion
The comparison of hospital at home care and inpatient hospital care must of course go further than the approach presented here, which was limited to expenditure for French public health insurance. In addition, it would be important to compare, from a societal point of view, production costs for hospital at home and inpatient care [8]. In effect, by comparing two forms of chemotherapy administration (at home or in a hospital day-care unit), we showed that the first method was at least as costly
Acknowledgement
This study was funded by a grant from the Direction de la Sécurité Sociale (Ministère de l’Emploi et de la Solidarité).
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