The European Journal of Health Economics

, Volume 8, Issue 4, pp 325–332 | Cite as

The impact of home hospitalization on healthcare costs of exacerbations in COPD patients

  • Jaume Puig-JunoyEmail author
  • Alejandro Casas
  • Jaume Font-Planells
  • Joan Escarrabill
  • Carme Hernández
  • Jordi Alonso
  • Eva Farrero
  • Gemma Vilagut
  • Josep Roca
Original paper


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.


COPD 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.


  1. 1.
    Kidney, J., McManus, T., Coyle, T.V.: Exacerbation of chronic obstructive pulmonary disease. Thorax 57, 753–754 (2002)CrossRefGoogle Scholar
  2. 2.
    Salazar, A., Corbella, X., Sanchez, J.L., Argimon, J.M., Escarrabill, J.: How to manage the ED crisis when hospital and/or ED capacity is reaching its limits. Report about the implementation of particular interventions during the Christmas crisis. Eur. J. Emerg. Med. 9, 79–80 (2002)CrossRefGoogle Scholar
  3. 3.
    Hanratty, B., Robinson, M.: Coping with winter bed crises. BMJ 319, 1511–1512 (1999)Google Scholar
  4. 4.
    Ruchlin, H.S., Dasbach, E.J.: An economic overview of chronic obstructive pulmonary disease. Pharmacoecon 19, 623–642 (2001)CrossRefGoogle Scholar
  5. 5.
    Sullivan, S.D., Ramsey, S.D., Lee, T.A.: The economic burden of COPD. Chest 117, 5S–9S (2000)CrossRefGoogle Scholar
  6. 6.
    Shepperd, S., Harwood, D., Gray, A., Jenkinsion, C., Vessey, M., Morgan, P.: Randomised controlled trial comparing hospital at home care with inpatient hospital care. I: Three month follow-up of health outcomes. BMJ 316, 1786–1791 (1998)Google Scholar
  7. 7.
    Shepperd, S., Harwood, D., Gray, A., Vessey, M., Morgan, P.: Randomised controlled trial comparing hospital at home care with inpatient hospital care. II: Cost minimisation analysis. BMJ 316, 1791–1796 (1998)Google Scholar
  8. 8.
    Coast, J., Richards, S.H., Peters, T.J., Gunnell, D.J., Darlow, M.A., Pounsford, J.: Hospital at home or acute hospital care? A cost minimisation analysis. BMJ 316, 1802–1806 (1998)Google Scholar
  9. 9.
    Skwarska, E., Cohen, G., Skwarski, K.M., Lamb, C., Bushell, D., Parker, S., MacNee, W.: Randomized controlled trial of supported discharge in patients with exacerbations of chronic obstructive pulmonary disease. Thorax 55, 907–912 (2000)CrossRefGoogle Scholar
  10. 10.
    Cotton, M.M., Bucknall, C.E., Dagg, K.D., Johnson, M.K., MacGregor, G., Stewart, C., Stevenson, R.D.: Early discharge for patients with exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial. Thorax 55, 902–906 (2000)CrossRefGoogle Scholar
  11. 11.
    Davies, L., Wilkinson, M., Bonner, S., Calverley, P.M., Angus, R.M.: “Hospital at home” versus hospital care in patients with exacerbations of chronic obstructive pulmonary disease: prospective randomised controlled trial. BMJ 321, 1265–1268 (2000)CrossRefGoogle Scholar
  12. 12.
    Hernandez, C., Casas, A., Escarrabill, J., Alonso, J., Puig-Junoy, J., Farrero, E., Vilagut, G., Collvinent, B., Rodriguez-Roisin, R., Roca, J.: Home hospitalization of exacerbated chronic obstructive pulmonary disease patients. Eur. Respir. J. 21, 58–67 (2003)CrossRefGoogle Scholar
  13. 13.
    Duan, N.: Smearing estimate: a nonparametric retransformation method. J. Am. Stat. Assoc. 78, 605–610 (1983)CrossRefGoogle Scholar
  14. 14.
    Lipscomb, J., Ancukiewicz, M., Parmigiani, G., Hasselblad, V., Samsa, G., Matchar, D.B.: Predicting the cost of illness: a comparison of alternative models applied to stroke. Med. Decis. Making. 18(Suppl), S39–S56 (1998)CrossRefGoogle Scholar
  15. 15.
    Briggs, A., Gray, A.: The distribution of health care costs and their statistical analysis for economic evaluation. J. Health Serv. Res. Policy 3, 233–245 (1998)Google Scholar
  16. 16.
    Sterne, J.A.C., Smith, G.D.: Shifting the evidence—what’s wrong with significance tests?. BMJ 322, 226–231 (2001)CrossRefGoogle Scholar
  17. 17.
    Briggs, A.H., O’Brien, B.J.: The death of cost-minimisation analysis?. Health Econ. 10, 179–184 (2001)CrossRefGoogle Scholar
  18. 18.
    World Health Organization.: Innovative Care for Chronic Conditions. Meeting Report (2001)Google Scholar
  19. 19.
    Wagner, E.H., Groves, T.: Care for chronic diseases. BMJ 325, 913–914 (2002)CrossRefGoogle Scholar
  20. 20.
    Dixon, J., Lewis, R., Rosen, R., Finlayson, B., Gray, D.: Can the NHS learn from US managed care organizations? BMJ 328, 223–226 (2004)CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Jaume Puig-Junoy
    • 1
    Email author
  • Alejandro Casas
    • 2
  • Jaume Font-Planells
    • 1
  • Joan Escarrabill
    • 3
  • Carme Hernández
    • 2
  • Jordi Alonso
    • 4
  • Eva Farrero
    • 3
  • Gemma Vilagut
    • 4
  • Josep Roca
    • 2
  1. 1.Research Center for Health and Economics (CRES)Universitat Pompeu FabraBarcelonaSpain
  2. 2.Servei de Pneumologia, Technology Innovation Unit, Hospital Clínic IDIBAPSBarcelonaSpain
  3. 3.UFISS-Respiratòria (Servei de Pneumologia), Hospital Universitari de BellvitgeUniversitat de BarcelonaBarcelonaSpain
  4. 4.Health Services Research UnitInstitut Municipal d’Investigació Mèdica (IMIM-IMAS)BarcelonaSpain

Personalised recommendations