| Abstract
| - Objectives: to compare the cost effectiveness of post-acute care for older people provided in community hospitals with general hospital care. Design: cost-effectiveness study embedded within a randomised controlled trial. Setting: seven community hospitals and five general hospitals at five centres in the midlands and north of England. Participants: 490 patients needing rehabilitation following hospital admission with an acute illness. Intervention: multidisciplinary team care for older people in community hospitals. Measurements: EuroQol EQ-5D scores transformed into quality-adjusted life years; health and social service costs during the 6-month period following randomisation. Results: there was a non-significant difference between the community hospital and general hospital groups for changes in quality-adjusted life-year values from baseline to 6 months (mean difference 0.048; 95% confidence interval −0.028 to 0.123; P = 0.214). Resource use was similar for both groups. The mean (standard deviation) costs per patient for health and social services resources used were comparable for both groups: community hospital group £8,946 (£6,514); general hospital group £8,226 (£7,453). These findings were robust to sensitivity analyses. The incremental cost-effectiveness ratio estimate was £16,324 per quality-adjusted life year. A cost effectiveness acceptability curve suggests that if decision makers' willingness to pay per quality-adjusted life year was £10,000, then community hospital care was effective in 47% of cases, and this increased to only 50% if the threshold willingness to pay was raised to £30,000. Conclusions: the cost effectiveness of post-acute rehabilitation for older people was similar in community hospitals and general hospitals.
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