Better care for less money: cost‐effectiveness of integrated care in multi‐episode patients with severe psychosis. (12th January 2020)

• Record Type: Journal Article
• Authors: Karow, A.; Brettschneider, C.; Helmut König, H.; Correll, C.U.; Schöttle, D.; Lüdecke, D.; Rohenkohl, A.; Ruppelt, F.; Kraft, V.; Gallinat, J.; Lambert, M.
• Is Part Of: Acta psychiatrica Scandinavica. Volume 141:Number 3(2020)
• Page Start: 221
• Page End: 230
• Publication Date: 2020-01-12
• Subjects: Schizophrenia -- bipolar disorder -- severe mental illness -- assertive community treatment -- cost utility -- QALY; Psychiatry -- Periodicals; 616.89
• DOI: 10.1111/acps.13139
• Languages: English
• ISSNs: 0001-690X

Abstract

Abstract : Objective: To compare cost‐effectiveness of integrated care with therapeutic assertive community treatment (IC‐TACT) versus standard care (SC) in multiple‐episode psychosis. Method: Twelve‐month IC‐TACT in patients with schizophrenia‐spectrum and bipolar I disorders were compared with a historical control group. Primary outcomes were entropy‐balanced cost‐effectiveness based on mental healthcare costs from a payers' perspective and quality‐adjusted life years (QALYs) as a measure of health effects during 12‐month follow‐up. Results: At baseline, patients in IC‐TACT ( n = 214) had significantly higher illness severity and lower functioning than SC ( n = 56). Over 12 months, IC‐TACT had significantly lower days in inpatient (10.3 ± 20.5 vs. 28.2 ± 44.9; P = 0.005) and day‐clinic care (2.6 ± 16.7 vs. 16.4 ± 33.7; P = 0.004) and correspondingly lower costs (€−55 084). Within outpatient care, IC‐TACT displayed a higher number of treatment contacts (116.3 ± 45.3 vs. 15.6 ± 6.3) and higher related costs (€+1417). Both resulted in lower total costs in IC‐TACT (mean difference = €−13 248 ± 2975, P < 0.001). Adjusted incremental QALYs were significantly higher for IC‐TACT versus SC (+0.10 ± 0.37, P = 0.05). The probability of cost‐effectiveness of IC‐TACT was constantly higher than 99%. Conclusion: IC‐TACT was cost‐effective compared with SC. The use of prima facies 'costly' TACT teams is highly recommended to improve outcomes and save total cost for patients with severe psychotic disorders.