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Better care for less money: cost-effectiveness of integrated care in multi-episode patients with severe psychosis.

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.

Authors+Show Affiliations

Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Recognition and Prevention Program, Zucker Hillside Hospital, New York, NY, USA. Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, New York, NY, USA. Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31814102

Citation

Karow, A, et al. "Better Care for Less Money: Cost-effectiveness of Integrated Care in Multi-episode Patients With Severe Psychosis." Acta Psychiatrica Scandinavica, 2019.
Karow A, Brettschneider C, Helmut König H, et al. Better care for less money: cost-effectiveness of integrated care in multi-episode patients with severe psychosis. Acta Psychiatr Scand. 2019.
Karow, A., Brettschneider, C., Helmut König, H., Correll, C. U., Schöttle, D., Lüdecke, D., ... Lambert, M. (2019). Better care for less money: cost-effectiveness of integrated care in multi-episode patients with severe psychosis. Acta Psychiatrica Scandinavica, doi:10.1111/acps.13139.
Karow A, et al. Better Care for Less Money: Cost-effectiveness of Integrated Care in Multi-episode Patients With Severe Psychosis. Acta Psychiatr Scand. 2019 Dec 8; PubMed PMID: 31814102.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Better care for less money: cost-effectiveness of integrated care in multi-episode patients with severe psychosis. AU - Karow,A, AU - Brettschneider,C, AU - Helmut König,H, AU - Correll,C U, AU - Schöttle,D, AU - Lüdecke,D, AU - Rohenkohl,A, AU - Ruppelt,F, AU - Kraft,V, AU - Gallinat,J, AU - Lambert,M, Y1 - 2019/12/08/ PY - 2019/12/04/accepted PY - 2019/12/10/pubmed PY - 2019/12/10/medline PY - 2019/12/10/entrez KW - QALY KW - Schizophrenia KW - assertive community treatment KW - bipolar disorder KW - cost utility KW - severe mental illness JF - Acta psychiatrica Scandinavica JO - Acta Psychiatr Scand N2 - 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. SN - 1600-0447 UR - https://www.unboundmedicine.com/medline/citation/31814102/Better_care_for_less_money:_cost-effectiveness_of_integrated_care_in_multi-episode_patients_with_severe_psychotic_disorders L2 - https://doi.org/10.1111/acps.13139 DB - PRIME DP - Unbound Medicine ER -