The cost-effectiveness of a nursing home-based transitional care unit for increasing the potential for independent living in the community among hospitalized older adults

Figures & data

Table 1. Baseline characteristics of SAFE Unit and usual care patients, before and after matching.

Characteristic	Unmatched cohort			Matched cohort
	SAFE patients, N (%)	Usual care patients, N (%)	Standard difference	SAFE patients, N (%)	Usual care patients, N (%)	Standard difference
	N = 155	N = 3,336		N = 154	N = 154
Sex
Female	95 (61.3%)	1,972 (59.1%)	0.04	94 (61.0%)	94 (61.0%)	0.00
Male	60 (38.7%)	1,364 (40.9%)	0.04	60 (39.0%)	60 (39.0%)	0.00
Age, mean ± SD	82.49 ± 9.00	79.95 ± 9.68	0.27	82.47 ± 9.03	82.47 ± 9.02	0.00
Geography
Urban	150–154^a (96.8–99.3%)	2,981 (89.4%)	0.36	149–153^a (96.8–99.4%)	149–153^a (96.8–99.4%)	0.04
Rural	1–5^a (0.6–3.2%)	325 (9.7%)	0.34	1–5^a (0.6–3.2%)	1–5^a (0.6–3.2%)	0.04
Comorbidities
Arrythmia	38 (24.5%)	386 (11.6%)	0.34	37 (24.0%)	37 (24.0%)	0.00
Stroke	12 (7.7%)	497 (14.9%)	0.23	12 (7.8%)	9 (5.8%)	0.08
CHF	87 (56.1%)	936 (28.1%)	0.59	86 (55.8%)	84 (54.5%)	0.03
COPD	52 (33.5%)	678 (20.3%)	0.30	51 (33.1%)	47 (30.5%)	0.06
Dementia	24 (15.5%)	1,170 (35.1%)	0.46	24 (15.6%)	24 (15.6%)	0.00
ACG score, mean ± SD	13.74 ± 3.27	12.86 ± 3.47	0.26	13.70 ± 3.24	13.87 ± 3.16	0.05
Lower respiratory tract infection	50 (32.3%)	467 (14.0%)	0.44	49 (31.8%)	47 (30.5%)	0.03
Prior acute care admission (within six months prior to index)
0	101 (65.2%)	2,517 (75.4%)	0.23	100 (64.9%)	102 (66.2%)	0.03
1	36 (23.2%)	605 (18.1%)	0.13	36 (23.4%)	34 (22.1%)	0.03
2+	18 (11.6%)	214 (6.4%)	0.18	18 (11.7%)	18 (11.7%)	0.00

^aActual count suppressed due to small cell size.

Table 2. Breakdown of effectiveness and cost (in CAD$2019).

	Matched cohort
	SAFE patients		Usual care patients		Difference	(95% CI)
	N = 154	(95% CI)	N = 154	(95% CI)
Mean institution-free days^a, days	161.97	(156.34, 167.61)	140.55	(132.34. 148.77)	21.42	(12.28, 31.02)
Mean total cost of care^b, CAD$	23,187.70	(20,894.67, 25,480.82)	24,293.60	(16,207.77, 32,379.38)	−1,105.80	(−10,318.79, 6,129.40)
Mean total cost of index hospitalization	13,603.90	(11,558.98, 15,648.92)	24,293.60	(16,207.77, 32,379.38)	−10,689.60	(−19,747.83, −3,469.67)
Mean total cost of SAFE Unit	9,583.80	(8,741.30, 10,426.30)	N/A		9,583.80	(8,741.30, 10,426.30)
ICER					SAFE unit is dominant^c

^aThis was calculated as 180 minus days spent in hospital (acute care and mental health hospital), rehabilitation facility, complex continuing care facility or nursing home.

^bTotal cost of care is calculated as the sum of the total cost incurred during index hospitalization and total cost of SAFE Unit.

^cLower costs and more institution-free days.

Table 3. Breakdown of service use (in days) within 180 days post-discharge.

Service type	Matched cohort (mean)
	SAFE Unit patients		Usual care patients		Difference	(95% CI)
	N = 154	95% CI	N = 154	95% CI
Institution-free days	161.97	(156.34 , 167.61)	140.55	(132.34 , 148.77)	21.42	(12.28 , 31.02)
Acute care hospital	9.80	(6.77, 12.83)	7.05	(4.91, 9.19)	2.75	(−0.57, 6.54)
Nursing home	4.55	(1.36, 7.75)	14.22	(7.86, 20.58)	−9.67	(−17.06, −2.71)
Rehabilitation facility	1.06	(0.34, 1.79)	9.51	(6.82, 12.21)	−8.45	(−11.18, −5.79)
Mental health hospital	0.12	(−0.11, 0.35)	0.00		0.12	(0.00, 0.35)
Complex continuing care	2.71	(0.56, 4.86)	9.01	(3.97, 14.05)	−6/30	(−11.8, −1.5)
Institution-free days without service	105.89	(95.60, 116.17)	80.19	(69.51 , 90.87)	25.70	(12.56, 39.05)
Home care	52.16	(42.36, 61.97)	58.01	(47.93, 68.10)	−5.85	(−18.94, 7.47)
Primary care	10.34	(8.23, 12.45)	15.59	(13.39, 17.80)	−5.25	(−8.09, −2.15)
Emergency department	1.90	(1.50, 2.29)	2.03	(1.54, 2.52)	−0.13	(−0.80, 0.50)

Figure 1. Cost-effectiveness plane.

Figure 2. Cost-effectiveness acceptability curve.