Cost-effectiveness of post-discharge home care for reducing potentially avoidable readmissions in stage IV cancer.

Abstract

12031 Background: Approximately 39% of hospital readmissions among stage IV cancer patients are potentially avoidable. These readmissions increase healthcare costs, reduce quality of life, and increase mortality. Home-based care may reduce avoidable readmissions through symptom management and care coordination, but cost-effectiveness in this population remains unknown. Objective: To evaluate the cost-effectiveness of home with care versus home without care for stage IV solid tumors patients post-discharge, from an Ontario public payer perspective. Methods: A four-state Markov model (Care, Readmission, Discharged, Death) was developed with week-long cycles with a 180 day horizon. Weekly potentially avoidable readmission rates were 1.8% (home with care) versus 5.4% (home without care). Utilities (0.65 vs 0.55) and costs (home care $100/day; readmission $994/day) were from Canadian sources. Primary outcome was incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY). One-way, two-way, and probabilistic sensitivity analyses (1,000 simulations) were conducted. Value of information analysis quantified decision uncertainty. Costs and QALYs were discounted at 1.5% annually. Results: Home with care produced 0.166 QALYs at $12,251 versus 0.105 QALYs at $7,386, yielding 0.061 incremental QALYs (22 quality-adjusted days) at $4,865 incremental cost (ICER: $79,955/QALY). Home care cost was the most influential cost parameter with a threshold of $115/day. Probabilistic analysis showed 60% probability of cost-effectiveness at willingness-to-pay (WTP) $100,000/QALY, with acceptability curves crossing at $80,000/QALY. Expected value of perfect information peaked at $1,500/patient. Conclusions: Home with care may represent a cost-effective option for stage IV cancer patients at or below the commonly accepted Canadian WTP threshold of $100,000/QALY, with robust findings across sensitivity analyses. Program costs are the primary value determinant, supporting policy consideration for post-discharge support services. Cost-effectiveness results: Home with care versus home without care. Outcome Home with Care Home without Care Difference Total cost $12,251 $7,386 +$4,865 Total QALYs 0.166 0.105 +0.061 Quality-adjusted days 60.6 38.3 +22.3 ICER — — $79,955/QALY Probability cost-effective at WTP $100,000/QALY 60% 40% — QALY = quality-adjusted life-year; ICER = incremental cost-effectiveness ratio; WTP = willingness-to-pay. Costs in 2024 Canadian dollars.