Methods: This was a study of 82 individuals who received cancer treatment at home for at least 15 days, coordinated by a publicly funded cancer centre in Lyon, France. Patients receiving home care that would not have required inpatient hospitalization during the study period were excluded from the analysis. Direct costs for home care borne by the French public health insurance were calculated, including, for example, healthcare services carried out by physicians, nurses and other staff; medication, laboratory services and medical devices; renting or buying equipment, such as medical beds, IV feeding tubes, wheelchairs; and other miscellaneous items. To evaluate costs for inpatient hospitalization, a fictivehospital stay was reconstructed for each individual receiving home care, which corresponded to what would have been required in the hospital, had home care services not been available. Individuals were categorized into three groups according to the type of cancer care required: chemotherapy, palliative care, and other treatments (such as immunotherapy, IV feeding and antibiotic therapy). The cost of the home cancer care was evaluated against the fictive hospital stay.

Findings: Overall, the average cost to the French public health insurance for home care cancer treatments were notably lower than the corresponding fictive hospital costs, for all three cancer groups combined. The cost difference was greatest for the palliative care and other treatment groups, while no significant cost difference was found for the chemotherapy group.

Conclusions: From the perspective of the government, home cancer treatments were less costly than traditional inpatient hospital care. This study suggests that implementing home-based cancer care alternatives to hospitalization could potentially generate cost savings to public health insurance systems.

However, because this study evaluated costs from the perspective of the public payer, costs borne by the individual or family were not considered. Canadian decision makers may wish to build on the findings of this study and evaluate the cost effectiveness of home versus hospital cancer programs from a societal perspective, which would include costs borne by the individual and family receiving care. Furthermore, researchers and policy makers may wish to look at the application of this study to other health care services and disease entities.

Reference: Remonnay R, Devaux Y., Chvetzoff G, Morelle M, Carrere M O. "Cancer treatment at home or in hospital: What are the costs for French public health insurance? Findings of a comprehensive-cancer centre" Health Policy, 2005; 72:141-148.

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