Domiciliary clinics II: a cost minimisation analysis

OBJECTIVES: We compare the cost of assessing new referrals to an old age psychiatry service at the patient's home or a hospital-based clinic. METHOD: An old age psychiatry service in Liverpool where routine referrals were assessed at home (domiciliary clinic) was compared to an adjacent service which assessed people in an outpatient clinic. Activity levels for four years of the service were collected and analysed. A cost-minimization analysis was done using an algorithm which allowed all direct costs to the service to be taken into account. A sensitivity analysis changed key values of the algorithm allowing their relative contribution to be considered. RESULT: The domiciliary clinic was marginally cheaper than outpatient assessment (48 pounds sterling compared to 50 pounds sterling per successful assessment). The most important variables in determining the cost effectiveness of the service were non-attendance rates, the grade of doctor seeing the patient and the time spent traveling for the home assessment. CONCLUSIONS: Domiciliary initial assessments were comparable in cost to clinic assessments in this study but in other situations the cost will vary, depending on the key local variables.