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

다국어 초록 (Multilingual Abstract)

To compare cost‐effectiveness of integrated care with therapeutic assertive community treatment (IC‐TACT) versus standard care (SC) in multiple‐episode psychosis.
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.
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%.
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.