Pediatric Tele–Home Care Compared to Usual Care: Cost-Minimization Analysis (Preprint)

Abstract

BACKGROUND While home hospitalization has been a well-known and widespread practice for some time in the adult population, it has not been the same case in the paediatric setting. Simultaneously, telemedicine tools are a facilitator of the change in the healthcare model, which is increasingly focused on home care. In a pioneering way in Spain, the in-home hospitalization program of the Hospital Sant Joan de Déu in Barcelona allows the child to be in their home environment at the time they are being monitored and clinically followed by the professionals. In addition to being the preferred option for families, previous experience suggest that paediatric home hospitalization reduces costs, primarily thanks to savings on the structural cost of the stay. OBJECTIVE To compare the average cost of a discharge by telehomecare with the usual care and to analyse the main drivers of the differential costs of both care models. METHODS Cost-minimization analysis conducted under a hospital’s perspective, based on observational data and estimated retrospectively. A historical control group of similar patients in terms of clinical casuistry to children hospitalized at home was used for comparison. RESULTS A 24h stay at the hospital costs € 503.68, while the in-home hospitalization costs € 264.66 per day, representing a saving of almost half (48%) of the cost compared to usual care. The main savings drivers were the personnel costs (35.5% of the total), intermediate non-care costs (33.17%), and structural costs (19.04%). Home hospitalization involves a total stay 27.61% longer, but at a daily cost of almost half, represents a € 155 (9.01%) per 24h stay saving. CONCLUSIONS The cost analysis conducted under a hospital perspective shows that paediatric telehomecare is 9% cheaper compared to regular hospital care. These results motivate the most widespread implementation of the service from the point of view of economic efficiency, adding to previous experiences that suggest that it is also preferable from the perspective of user satisfaction.