Healthcare costs and productivity losses associated with county-based home-care service for sick children in Sweden.
Charlotte Castor, Kristian Bolin, Helena Hansson and 2 others
PMID 31985851WHAT IT FOUND
Home-care service for 32 sick children in Sweden was estimated to cost SEK 50 101 less per child each year than estimated hospital-only care, while parents still lost substantial work time.
This observational study cannot prove the service caused the saving.
Key findings
01The average annual healthcare cost for one child when home-care service was part of care was SEK 50 101 lower than the estimated alternative of hospital-only care.
02Twenty-five parents had total estimated productivity losses of 3.3 million SEK over one year; mothers' median losses were more than double fathers', but the mean differences were not significant.
03Six children received palliative home-care service, costing 927 185 SEK in total, which was 73% of total home-care healthcare costs and left an estimated total cost reduction of SEK 37 722 compared with alternative care.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was not a full health-economic evaluation, and the hospital-only comparison was estimated rather than observed. No significance test was done for healthcare costs because healthcare utilisation varied widely. The sample was small and diverse: 32 children, and only 25 parents were analysed for productivity losses. The study cannot separate the effects of home-care service components, which included 24-hour nurse and physician services plus daytime physiotherapist, occupational therapist, dietician and counsellor services. The study cannot determine whether parental absence was due to home-care service or the child's illness. Results are from a Swedish county and depend on Swedish social insurance, so they may not transfer to other health systems. Only families able to understand and respond to Swedish instructions were included.
Declared interests
Funded by the Swedish Childhood Cancer Foundation, the Lions Research Foundation in Skåne, the Jonas Foundation, Region Skåne and the Mjölkdroppen Foundation. The supplied text lists funding but no author conflict-of-interest declaration.
The easy way to misread this
Do not read the SEK 50 101 lower average annual cost as proof that home care saves money in practice. The comparison was with estimated hospital-only care, not an observed hospital group, and the home-care service included 24-hour nurse and physician services plus daytime physiotherapist, occupational therapist, dietician and counsellor services. The study cannot separate the contribution of any single component.