This paper is original and contributes to the literature by providing evidence to show that a health-social partnership transitional care program is cost-effective in reducing healthcare costs and attaining QALY gains. Previous studies have provided evidence to support that transitional care can help reduce hospital readmissions and enhance clinical outcomes. However, these interventional programs tend to use healthcare professionals as the sole providers. There is no study that could be identified using volunteers in transitional care programs. There were programs that used volunteers or lay persons to provide support for patients, either hospital-based or community-based, and found them helpful to provide support to the patients. Based on findings from previous evidence which showed that transitional care model is effective and that volunteers can be conducive to patient outcomes, we built a health-social partnership transitional care model. There is a paucity of studies executing a full cost-effective analysis on transitional care model. This study fills the knowledge gap and demonstrated that the health-social partnership transitional care program is cost effective and brings about QALY gains.
The contemporary trend in post-discharge support services advocates health and social partnership [25, 26] because clients returning home require different types of social support. Faulkner & Davies  outlined four types of social support: instrumental support, involving the provision of tangible resources to alleviate difficulties; appraisal support, which helps individuals to evaluate the impact of situations; informational support, which provides individuals with information to deal with problems; and emotional support, which enhances self-esteem and encouragement. In this study, the nurse case managers provided all four types of support, and the volunteers backed up by the social workers provided informational and emotional support . The literature has reported studies that involved volunteers in patient programs, but the findings are limited to the descriptive level. Karwalajtys et al.  have reported using volunteer peer educator in the community to enhance cardiovascular health awareness. Sandhaus et al.  have involved volunteers to help reduce delirium among elderly in the hospital. Both studies remarked that the use of volunteers is a low-cost method of providing sustainable support to patients and the volunteers were welcomed by patients, their families, and nursing staff. However, no studies can be identified that report either health outcomes or cost-effectiveness when volunteers are included in the patient support programs. The integration of health and social care services as a newly-developed initiative needs the support of evidence to convince policy-makers of its value in both health outcomes and cost . With the demand for healthcare resources across competing programs, cost analysis in health care is essential .
Of all healthcare expenses, hospital use occupies the major part of the expenditure . Readmission rate is a commonly used outcome in health services research, and some studies have included cost as one of their outcome variables. How do the cost-related outcomes reported in those studies compare to this study? Since the content and length of the intervention programs, as well as the type and number of providers, vary among studies, it is very difficult to make a fair comparison of the results. Also, the intervention cost varies in different healthcare contexts. The following descriptive review will, however, help provide a synopsis of the cost savings in different places, thus helping readers to appreciate the extent of the cost savings reported in this study.
In a 12-week program with regular telephone contacts and education for heart failure patients after hospital discharge in Ireland, the cost was €5860 per patient. The intervention produced a net cost saving of €37,216 for 51 patients over 3 months . Another 12-week transitional post-discharge care program introduced in the United States using advanced practice nurses also to follow up heart failure patients saved US$4,845 per patient over a year, with the intervention and control group spending respectively US$7,636 and US$12,481 . A 6-month program was introduced to a group of elderly patients after leaving the hospital by geriatricians targeting risk factors for preventable readmissions in France. The mean cost of the intervention was €278 per patient, and the cost savings balanced against the cost of the intervention was €519 per patient . Kwok et al.  provided regular nurse home visits also for 6 months to discharged elderly patients in Hong Kong, and the intervention cost was US$309 per subject. The mean total public health expenditure was reported to be lower in the intervention group, with a saving of US$2024 per patient. For a longer program of 12 months adopted for a group of post-discharge stroke patients involving health and social care in England, the cost of domiciliary care was £6840, which was cheaper when compared to the other two modes of interventions implemented by the stroke unit (£11450) and stroke team (£9527). The mean QALY gained were respectively 0.297, 0.216 and 0.221 for stroke unit, stroke team and domiciliary care, and there was a 59% probability of domiciliary care being cost-effective . Another 1-year telephone support program was provided to community diabetes patients registered in a district in England, with the intervention estimated to cost £43000/QALY and to have a 29% probability of being cost-effective when measured against a threshold of £30000/QALY  All of the above programs used healthcare professionals as key service providers. The study by Richardson et al.  in England is one of the few that evaluated a program involving non-health professionals, a layperson-led self-care group. The group acted as expert patients, teaching other patients self-care support skills for long-term conditions in six weekly sessions in the community. The intervention was found to be associated with better patient outcomes at a slightly lower cost. There was a 0.020 QALY gain of the intervention group when compared with the control group, and a probability of 94% of being cost-effective when the value of £20000/QALY was considered.
This study spent HK$1225 (=US$158) per patient for the study group, and the cost of readmission per subject was reduced by HK$1490 (=US$192) and HK$2970 (=US$383) respectively at 28 and 84 days. The intervention had an 89% chance of being cost-effective when checked against the NICE threshold of £20000/QALY . The expenditure figures reported in this study were substantially lower than in any of the studies reported above, and there was a high probability that the HSTCMP was effective when using the NICE threshold.