The impact of home hospitalization on healthcare costs of exacerbations in COPD patients
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Home-hospitalization (HH) improves clinical outcomes in selected patients with chronic obstructive pulmonary disease (COPD) admitted at the emergency room due to an exacerbation, but its effects on healthcare costs are poorly known. The current analysis examines the impact of HH on direct healthcare costs, compared to conventional hospitalizations (CH). A randomized controlled trial was performed in two tertiary hospitals in Barcelona (Spain). A total of 180 exacerbated COPD patients (HH 103 and CH 77) admitted at the emergency room were studied. In the HH group, a specialized respiratory nurse delivered integrated care at home. The average direct cost per patient was significantly lower for HH than for CH, with a difference of 810€ (95% CI, 418–1,169€) in the mean cost per patient. The magnitude of monetary savings attributed to HH increased with the severity of the patients considered eligible for the intervention.
KeywordsCOPD Healthcare costs Healthcare delivery Homecare Hospitalization
We are grateful to Joan Albert Barberà, MD, Ernest Sala, MD, Enrique Gavela, MD, and the nurses Isabel Fernandez, RN, and Consol Fornas, from the Hospital Clínic for their support during the study and in the preparation of the manuscript. We also acknowledge the support of Nuria Celorrio, MD, and the nurse Marian Maderal from Hospital de Bellvitge for their valuable contribution. We are indebted to Mrs. Rosalia Santed from the IMIM for his job in the preparation of the database. We thank José María Marín, MD, from the Hospital Miguel Servet (Zaragoza) for his collaboration in the design of the protocol. Finally, we are grateful to all the partners of the CHRONIC project: CSC, Barcelona, Spain, Albert Alonso MD, José A. Montero, Javier Pastor and Bernat Sifre; UPM, Madrid, Spain, Francisco del Pozo, Paula de Toledo, Silvia Jiménez; CESTEL, Madrid, Spain, Fernando Ortiz, Luis Mena, Max Godoy, José Luís Sirera; CSIC-CNM, Barcelona, Spain, Jordi Aguiló, Luís Sánchez, Antón Guimerà; SMS, Milano, Italy, Alessandro Falco, Daniela Balconi; SMS, Madrid, Spain, Begoña Andrés, José J. Moratillas; ICP, Milano, Italy, Andrea Mattiussi, Angelo Antonini,(Parkinson Center); MC, Milano, Italy,Carlo Castiglioni, Elvia Battaglia; TILAB, Turín, Italy, Fabrizio Moggio, Marco Mercinelli; KUL, Leuven, Belgium, Marc Decramer, Thierry Troosters, Walter Droogne, F. Van de Werf; EW, Paris, France, Peter Sylvester, Nicolas Pougetoux; ALAMO, Madrid, Spain, Miguel Angel García Matatoros, Alberto Marcus; UB, Barcelona, Spain, Ramon Farré; ECOMIT, Barcelona, Spain, Carmen Céinos.
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