Cost Savings: Home Versus Inpatient Infusion Therapy, A Review of the Literature
Authors:   National Home Infusion Association, Haines Danell 
Published: February 2025

Introduction: Home infusion is a site of care (SOC) option for patients requiring intravenous (IV) or subcutaneous (SC) medications for treatment of acute and chronic medical conditions. Patients and payors have become aware of the sizeable cost savings associated with home infusion when compared to other SOC. There is a need to gain an understanding of the amount of savings associated with home infusion when compared to other SOCs such as the hospital. The literature review objective is to provide a critical evaluation of the current evidence of the cost savings associated with home and outpatient infusion therapy when compared to inpatient therapy.

Methods: The literature search was conducted between July 1, 2023, and August 2, 2023, and focused on terms related to home infusion, home-based, homecare, outpatient or infusion followed by cost, cost comparison, cost savings, or SOC optimization. PubMed through the National Library of Medicine was searched. After reviewing the articles, it was determined that it is not feasible to compare U.S. health care cost results to other countries due to significant differences in health care systems, financial resources, and co-payment systems, thus studies conducted outside of the U.S. were excluded.

Results: Six articles met the review inclusion criteria. The first article was a cost analysis of a home infusion anti-infective program and showed that the savings per home infusion patient was $40,460 when compared to inpatient costs. Another article investigated the cost of home and inpatient anti-infective infusion and determined that the cost per day for home infusion was $122 while the cost for inpatient was $798. The third article calculated the cost difference of home infusion enzyme replacement with inpatient therapy and concluded a significant difference (p≤.0001) existed between the SOC costs. One study focused on developing a cost model using patient care information that included Medicare data. The model showed a cumulative 5-year savings of nearly $3 billion in 2023 health care dollars. The last article compared the home and inpatient infusion cost of inotropic therapy and concluded that the home infusion savings was $71,300 to $120,500 per patient.

Discussion: The reviewed studies demonstrate significant cost savings when the home is the SOC for infusion therapy, especially for IV antimicrobial treatment. This is significant as IV anti-infective therapies comprise nearly half of all treatments done at home today. One study provides evidence for savings associated with enzyme replacement; a therapy analogous to the growing number of specialty biologics being used today to manage chronic diseases. Despite evidence of cost savings Medicare has not developed a home infusion benefit comparable to what is available in the private sector.

Conclusions: The literature review provides evidence of consistent cost savings associated with home and outpatient infusion therapy when compared to the inpatient SOC for a range of infused drugs. The study with the most rigorous methodology involved a model that showed a 5-year Medicare savings of $3 billion in today’s dollars with the implementation of a home infusion anti-infective therapy Medicare benefit.

Keywords: Home Infusion, Site of Care, Cost, Medicare, Homecare