Hanne Nørby Jesper Neumann

1. A follow home arrangement to elderly medical patients, who are discharged from hospital - a cost-benefit analysis Hanne Nørby Jesper Neumann

2. Background Examinations from The Danish National Health Authority (Sundhedsstyrelsen) have shown, that there is a Great risk of re-admission when elderly medical patients are discharged from hospital Risk of re-admission is highest just after elderly medical patients are discharged from hospital Great risk of less coherent care pathway for elderly medical patients (because of not enough coordination between the hospital and the primary health care sector).

3. Background Re-admission rates among elderly patients (> 66 years) for selected disease (0-30 days after being discharged) • 29 % for chronic obstructive pulmonary disease • 24 % for dehydration • 23 % for pneumonia • 21 % for cystitis Source: Report from The Danish National Health Authority (Sundhedsstyrelsen): Re-admission of elderly in Denmark 2008

4. Objective of the evaluation To evaluate the economic effects of follow home arrangement to elderly medical patients after discharged from hospital

5. Decision tree

6. Costs Direct expenses. Expenses directly related to the intervention (wages, medicine and transportation). Indirect expenses. Lost of earnings for those participating in the intervention (no indirect expenses in this study). Intangible expenses in the form of more safety for the patients is not included.

7. Direct expenses Intervention expenses for each patient is estimated to 850 kr. (including transportation and wages). Expenses for treatment in hospital is in average for each intervention patient 29.766 kr. Expenses for treatment in hospital is in average for each control patient 32.931 kr.

8. Direct costs in average pr. patient The intervention results in a total gain of 2.725 kr. pr. patient.

9. Sensitivity analysis A 20 % rise in intervention expenses for each patient increases intervention expenses to 964 kr. The gain of the intervention will fall from 2.725 kr. to 2.611 kr. pr. patient. A 10 % rise in hospital expenses for each intervention patient. The intervention will results in a total loss of 473 kr. pr. patient. A rise of 8,5 % in hospital expenses for each intervention patient, will results in a gain of 0 kr. In other words the intervention breaks even.

10. Conclusion The intervention results in a total gain of 2.725 kr. pr. patient. A rise in intervention or hospital expenses lowers the gain of the intervention or may result in a total loss pr. patient.