Evidence map›Paper›PMID 34969074›Full record

Trial reportAge and ageing2022

Is comprehensive geriatric assessment hospital at home a cost-effective alternative to hospital admission for older people?

Surya Singh, Alastair Gray, Sasha Shepperd, David J Stott, Graham Ellis, Anthony Hemsley, Pradeep Khanna, Scott Ramsay, Rebekah Schiff, Apostolos Tsiachristas and 2 more

Open access · hybridAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Age and ageing, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
33citing papers in PubMed, 8 pooled it
0.2field-weighted citation impact, top 46% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

33 citing papers in PubMed, 8 syntheses or guidelines pooled it, 2 citations in OpenAlex.

  1. Pooled it
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  7. Admission avoidance hospital at home.The Cochrane database of systematic reviews · 2024
    Pooled it
  8. The Cost-Effectiveness of Homecare Services for Adults and Older Adults: A Systematic Review.International journal of environmental research and public health · 2023
    Pooled it
  9. Trial
  10. Cost-Effectiveness of Hospital-at-Home and Fecal Microbiota Transplantation in Treating Older Patients With Clostridioides difficile.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025
    Trial
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  12. Observational
  13. Observational
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  15. Article
  16. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 9 institutions in 1 country.

Surya SinghHealth Economics Research Centre, Nuffield Department of Population Health Sciences, Richard Doll Building, Old Road Campus, University of Oxford, Oxford OX3 7LF, UK.
Alastair GrayHealth Economics Research Centre, Nuffield Department of Population Health Sciences, Richard Doll Building, Old Road Campus, University of Oxford, Oxford OX3 7LF, UK.
Sasha ShepperdNuffield Department of Population Health Sciences, Richard Doll Building, Old Road Campus, University of Oxford, Oxford OX3 7LF, UK.ORCID 0000-0001-6384-8322
David J StottInstitute of Cardiovascular and Medical Sciences, University of Glasgow, New Lister Building Glasgow Royal Infirmary G31 2ER, Glasgow, UK.
Graham EllisUniversity Hospital Monklands, NHS Lanarkshire, Monkscourt Avenue, Airdrie, ML6 0JS, UK.
Anthony HemsleyRoyal Devon and Exeter NHS Foundation Trust, Exeter, Devon EX2 5DW, UK.
Pradeep KhannaAneurin Bevan University Health Board, Newport, South Wales, NP20 4SZ, UK.
Scott RamsaySt John's Hospital, NHS Lothian, Howden W Rd, Howden, Livingston EH54 6PP, UK.
Rebekah SchiffGuy's and St Thomas' NHS Foundation Trust, Westminster Bridge Rd, Bishop's, London SE1 7EH, UK.
Apostolos TsiachristasHealth Economics Research Centre, Nuffield Department of Population Health Sciences, Richard Doll Building, Old Road Campus, University of Oxford, Oxford OX3 7LF, UK.
Angela WilkinsonVictoria Hospital, NHS Fife, Hayfield Rd, Kirkcaldy, KY2 5AH, UK.
John YoungAcademic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK.
University of Oxford · GBAneurin Bevan University Health Board · GBBradford Royal Infirmary · GBGlasgow Royal Infirmary · GBGuy's and St Thomas' NHS Foundation Trust · GBNHS Fife · GBNHS Lanarkshire · GBNHS Lothian · GBRoyal Devon & Exeter NHS Foundation Trust · GB

Funding

Department of Health 12/209/66
6 · The paper itself

Abstract

backgroundhospital level healthcare in the home guided by comprehensive geriatric assessment (CGA) might provide a less costly alternative to hospitalisation for older people.

objectiveto determine the cost-effectiveness of CGA admission avoidance hospital at home (HAH) compared with hospital admission. DESIGN/

interventiona cost-effectiveness study alongside a randomised trial of CGA in an admission avoidance HAH setting, compared with admission to hospital. PARTICIPANTS/

settingolder people considered for a hospital admission in nine locations across the UK were randomised using a 2:1 randomisation schedule to admission avoidance HAH with CGA (N = 700), or admission to hospital with CGA when available (N = 355). MEASUREMENTS: quality adjusted life years, resource use and costs at baseline and 6 months; incremental cost-effectiveness ratios were calculated. The main analysis used complete cases.

resultsadjusting for baseline covariates, HAH was less costly than admission to hospital from a health and social care perspective (mean -£2,265, 95% CI: -4,279 to -252), and remained less costly with the addition of informal care costs (mean difference -£2,840, 95% CI: -5,495 to -185). There was no difference in quality adjusted survival. Using multiple imputation for missing data, the mean difference in health and social care costs widened to -£2,458 (95% CI: -4,977 to 61) and societal costs remained significantly lower (-£3,083, 95% CI: -5,880 to -287). There was little change to quality adjusted survival.

conclusionsCGA HAH is a cost-effective alternative to admission to hospital for selected older people.

Indexed as

Geriatric AssessmentHospitalizationAgedCost-Benefit AnalysisHospitalsHumansQuality-Adjusted Life Yearsadmission avoidance hospital at homecomprehensive geriatric assessmentcost-effectivenessolder people

Identifiers

PMID34969074
PMCPMC8753046
OpenAlexW3195159965

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.