Cost and Cost-Effectiveness Evidence for Hospital-at-Home Programs in Asia: A Systematic Review

Background/Objectives: Hospital-at-home (HaH) programs are increasingly adopted as an alternative to inpatient care and have demonstrated cost savings and comparable clinical outcomes in Western healthcare systems. In Asia, where healthcare systems face growing hospital-bed capacity constraints, evidence on the economic impact of HaH remains limited. This systematic review aimed to appraise and synthesize evidence on costs, resource utilization, and formal cost-effectiveness evaluation, where available, of HaH programs for patients eligible for general hospital admission within Asian healthcare systems. Methods: This systematic review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420251117897). Literature searches were performed in PubMed/MEDLINE, EMBASE, and the Cochrane Library from 2000 to June 2026. Studies evaluating HaH or similar home-based hospitalization models in Asian settings and reporting cost-related outcomes were included. Methodological quality was assessed using the Joanna Briggs Institute checklist for economic evaluations, and findings were synthesized using a dominance ranking matrix. Results: Of 2243 records identified, five studies from four Asian countries/regions involving 10,152 patients met the inclusion criteria. Four studies reported cost savings alongside favorable findings for selected clinical outcomes, including shorter hospital stays, although findings varied across outcomes and settings. No study reported a formal cost-effectiveness analysis. Overall, the dominance ranking matrix favored HaH in most scenarios, although one study reported less favorable outcomes. Conclusions: The limited available evidence suggested that HaH programs may reduce healthcare costs alongside favorable findings for selected clinical outcomes in some Asian healthcare settings. However, substantial heterogeneity and the absence of formal cost-effectiveness evaluations limit definitive conclusions regarding their cost-effectiveness.