The economic value of empowering older patients transitioning from hospital to home: Evidence from the 'Your Care Needs You' intervention

TL;DR

This study evaluates the cost-effectiveness of the 'Your Care Needs You' intervention, a patient-centered approach that empowers older adults during hospital discharge, showing potential for improved outcomes and reduced costs within the NHS.

Contribution

It provides empirical evidence on the cost-effectiveness of the YCNY intervention for older patients transitioning from hospital to home, using a UK-based randomized controlled trial.

Findings

YCNY reduced costs by a3269 per patient.

QALY gain of 0.0057 with YCNY.

89% probability of cost-effectiveness at a315,000/QALY threshold.

Abstract

Hospital-to-home transitions are a critical component of effective healthcare delivery, especially for patients aged 75 and older. This study evaluates the cost-effectiveness of the 'Your Care Needs You' (YCNY) intervention, a patient-centred approach designed to empower older adults during discharge, compared to standard care. The analysis adopts the perspective of the National Health Service (NHS) and Personal Social Services. Data were drawn from a cluster randomised controlled trial (cRCT) conducted within the UK NHS over a 90-day post-discharge follow-up period. Adjusted differences in costs and Quality-Adjusted Life Years (QALYs) were estimated using Multilevel Mixed-Effects Generalised Linear Models (MME-GLM) to account for the hierarchical structure of the trial design. Alternatively, Seemingly Unrelated Regression (SUR) models were employed to address potential correlations between costs and QALYs. Scenario analyses and probabilistic sensitivity analyses were conducted to assess the robustness of the results. The YCNY intervention reduced costs by {\pounds}269 and achieved a QALY gain of 0.0057, resulting in a net health benefit (NHB) of 0.0246 at a {\pounds}15,000/QALY threshold. It demonstrated an 89% probability of cost-effectiveness compared to standard care within the trial's time horizon. Findings remained robust across alternative scenarios and sensitivity analyses. These results suggest that YCNY is a promising and potentially cost-effective strategy for improving hospital-to-home transitions for older adults. By enhancing outcomes and reducing costs, the study supports integrating patient-centred interventions like YCNY into routine NHS practice, with the potential to improve both efficiency and quality of healthcare delivery.