Hunter, Rachael Maree;
Frost, Rachael;
Kalwarowsky, Sarah;
Marston, Louise;
Pan, Shengning;
Avgerinou, Cristina;
Clegg, Andrew;
... Walters, Kate; + view all
(2025)
Funding Health Promotion Activities to Reduce Avoidable Hospital Admissions in Frail Older Adults (HomeHealth): Further Challenges to the "Cost-Effective but Unaffordable" Paradox.
Applied Health Economics and Health Policy
, 23
(6)
pp. 1099-1113.
10.1007/s40258-025-00987-4.
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Abstract
Introduction: Health 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. / Methods: The 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. / Results: Participants 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.
| Type: | Article |
|---|---|
| Title: | Funding Health Promotion Activities to Reduce Avoidable Hospital Admissions in Frail Older Adults (HomeHealth): Further Challenges to the "Cost-Effective but Unaffordable" Paradox |
| Location: | New Zealand |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1007/s40258-025-00987-4 |
| Publisher version: | https://doi.org/10.1007/s40258-025-00987-4 |
| Language: | English |
| Additional information: | This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > UCL BEAMS UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Maths and Physical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences > Experimental Psychology UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Maths and Physical Sciences > Dept of Statistical Science UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Applied Health Research UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Primary Care and Population Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10217721 |
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