Evidence map›Paper›PMID 40632475›Full record

Trial reportApplied health economics and health policy2025

Funding Health Promotion Activities to Reduce Avoidable Hospital Admissions in Frail Older Adults (HomeHealth): Further Challenges to the "Cost-Effective but Unaffordable" Paradox.

Rachael Maree Hunter, Rachael Frost, Sarah Kalwarowsky, Louise Marston, Shengning Pan, Cristina Avgerinou, Andrew Clegg, Claudia Cooper, Vari M Drennan, Benjamin Gardner and 4 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Applied health economics and health policy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
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

1 citing paper in PubMed.

  1. Trial
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

14 authors.

Rachael Maree HunterResearch Department of Primary Care and Population Health, University College London, London, UK. r.hunter@ucl.ac.uk.ORCID 0000-0002-7447-8934
Rachael FrostPublic and Allied Health, Liverpool John Moores University, Liverpool, UK.
Sarah KalwarowskyResearch Department of Primary Care and Population Health, University College London, London, UK.
Louise MarstonResearch Department of Primary Care and Population Health, University College London, London, UK.
Shengning PanResearch Department of Primary Care and Population Health, University College London, London, UK.
Cristina AvgerinouResearch Department of Primary Care and Population Health, University College London, London, UK.
Andrew CleggAcademic Unit for Ageing and Stroke Research, University of Leeds, Bradford Institute for Health Research, Bradford, UK.
Claudia CooperWolfson Institute of Population Health, Queen Mary University of London, London, UK.
Vari M DrennanInstitute for Health, Education and Society, Kingston University, London, UK.
Benjamin GardnerDepartment of Psychology, University of Surrey, Guilford, UK.
Claire GoodmanCentre for Research in Public health and Community Care, University of Hertfordshire, Hatfield, UK.
Pip LoganFaculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.
Dawn A SkeltonDepartment of Physiotherapy and Paramedicine, Glasgow Caledonian University, Glasgow, UK.
Kate WaltersResearch Department of Primary Care and Population Health, University College London, London, UK.

Funding

Health Technology Assessment Programme NIHR128334
6 · The paper itself

Abstract

introductionHealth promotion initiatives are often promoted as being worth the investment given future cash-savings. This paper uses the findings of HomeHealth, a health promotion service for older adults with mild frailty, to examine how economic evaluation relates to local decision making in England.

methodsThe HomeHealth trial randomised 388 participants aged 65+ years with mild frailty to receive HomeHealth (195 participants) or treatment as usual (193 participants). Health and social care resource use and carer time were self-completed at baseline, 6 months and 12 months. Primary and secondary healthcare resource use and medications were collected from patient files at 12 months post recruitment, covering the past 18 months. Stakeholders including commissioners were consulted on the results of the trial and budget impact.

resultsParticipants allocated to HomeHealth had a significant reduction in emergency hospital admissions at 12 months (incident rate ratio (IRR) 0.65; 95% confidence interval (CI) 0.45-0.92) and unpaid carer hours at 6 months (- 16 h (95% CI - 18 to - 14 h) or - £360 (95% CI - 369 to - 351) per patient). Although the intervention is cost saving overall due to fewer emergency admissions, at a cost of £457 per patient commissioners do not have the budget to fund it. DISCUSSION: This case study illustrates the problem with using standard economic evaluation methods to argue for implementation of health promotion initiatives in publicly financed healthcare systems. Although HomeHealth resulted in reduced emergency admissions and may be cost saving to the system as a whole, it is not locally cash releasing. Health promotion initiatives are unlikely to be funded from local budgets without significant system-wide changes.

Indexed as

Frail ElderlyHealth PromotionHospitalizationAgedAged, 80 and overCost-Benefit AnalysisEnglandFemaleHumansMale

Identifiers

PMID40632475
PMCPMC12535928

What OpenQuestion holds

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Registered trials

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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.