Objective: The objective of this study was to compare the outcomes and costs of intensive case management with routine case management for a group of severely disabled patients with a mental illness.
Method: A cost-effectiveness analysis was conducted alongside a randomised con trolled trial. Seventy-three patients, who reside in the eastern suburbs of Sydney, were randomly allocated to either intensive or routine case management. Staff pro viding intensive case management had substantially lower caseloads than staff pro viding routine case management. The main health outcome measured was patients' level of functioning as measured by the Life Skills Profile. Costing data were collect ed from hospital services, mental health services, general health services, community services and informal carers.
Results: At 12 months, outcome and costing data were analysed on 58 patients and hospitalisation data were analysed on 68 patients. Significantly more patients in the intensive case management group remained in treatment (χ2 = 6.00, df = 1, p < 0.01) and showed a clinically significant improvement in functioning from base line to 12 months (χ2 = 4.50, df = 1, p < 0.05). The mean cost per patient was $7745 more in the intensive group than in the routine group (t = 1.49, df = 56, p > 0.01) over 12 months. The cost-effectiveness ratio indicated a cost of $27 661 per year for one additional patient in the intensive case management group to make a clinically significant improvement in functioning.
Conclusion: Intensive case management led to an increased rate of retention in treatment and a clinically significant improvement in functioning. Further comparative cost-effectiveness studies are required to determine whether $27 661 per year for one patient to make a clinically significant improvement in functioning is a cost-effective use of mental health resources.
HoultJReynoldsICharbonneau-PowisMWeekesPBriggsJ.Psychiatric hospital versus community treatment: the results of a randomised trial. Australian and New Zealand Journal of Psychiatry1983; 17:160–167.
2.
SteinLITestM. A.An alternative to mental hospital treatment-1. Conceptual model, treatment program and clinical evaluation. Archives of General Psychiatry1980; 37:392–397.
3.
WeisbrodBATestMASteinLIAlternative to mental hospital treatment–II. Economic benefit-cost analysis. Archives of General Psychiatry1980; 37:400–405.
4.
OlfsonM.Assertive community treatment: an evaluation of the experimental evidence. Hospital and Community Psychiatry1990; 41:634–641.
5.
BurnsBJSantosABAssertive community treatment: an update of randomised trials. Psychiatric Services1995; 46:669–675.
6.
JerrellJHuTWCost-effectiveness of intensive clinical and case management compared with an existing system of care. Inquiry1989; 26:224–234.
7.
BurnsTBeardsmoreABhatOliver AMathersC.A controlled trial of home-based acute psychiatric services. I: Clinical and social outcome. British Journal of Psychiatry1993; 163:49–54.
8.
MuijenMCooneyMStrathdeeGBellRHudsonA.Community psychiatric nurse teams: intensive support vs. generic care. British Journal of Psychiatry1994; 165:211–217.
9.
McCronePBeechamJKnappM.Community psychiatric nurse teams: cost-effectiveness of intensive support versus generic care. British Journal of Psychiatry1994; 165:218–221.
10.
BurnsTBeardsmoreABhatAOliverAMathersC.A controlled trial of home-based acute psychiatric services. II: Treatment patterns and costs. British Journal of Psychiatry1993; 163:55–61.
11.
EversSMAAVan WijkASAmentAJHAEconomic evaluation of mental health care interventions. A review. Health Economics1997; 6:161–177.
12.
DrummondMStoddartGTorranceG.Methods for the economic evaluation of health care programs. New York: Oxford University Press, 1987.
13.
O'BrienBJDrummondMFLabelleRJWillanA.In search of power and significance: issues in the design and analysis of stochastic cost effectiveness studies in health care. Medical Care1994; 32:150–163.
14.
SteinLIDiamondRJA program for difficult to treat patients. The training in community living model: a decade of experience. New Directions for Mental Health Services1985; 26:29–39.
15.
RosenAHadzi-PavlovicDParkerG.The Life Skills Profile: a measure assessing function and disability in schizophrenia. Schizophrenia Bulletin1989; 15:325–337.
16.
TrauerTDuckmantonRAChiuE.The assessment of clinically significant change using the Life Skills Profile. Australian and New Zealand Journal of Psychiatry1997; 31:257–263.
17.
Cooper-StanburyMSolonRCookM.Hospital utilisation and costs study 1991–92. Vol. 1. A survey of public hospitals and related data. Australian Institute of Health and Welfare: Health Services Series no. 5. Canberra: Australian Government Publishing Service, 1994.
18.
Australian Institute of Health and Welfare.Health expenditure bulletin, no. 11. Canberra: Australian Institute of Health and Welfare, 1995.
GrayAMMarshallALockwoodAMorrisJ.Problems in conducting economic evaluations alongside clinical trials. British Journal of Psychiatry1997; 170:47–52.
21.
DrummondMO'BrienB.Clinical importance, statistical significance and the assessment of economic and quality-of-life outcomes. Health Economics1993; 2:205–212.
22.
TrauerTDuckmantonRAChiuE.The Life Skills Profile: a study of its psychometric properties. Australian and New Zealand Journal of Psychiatry1995; 29:492–499.
23.
FranksD.Economic contributions of families caring for persons with severe and persistent mental illness. Administration and Policy in Mental Health1990; 18:9–18.
24.
ClarkRDrakeR.Expenditures of time and money in families of people with severe mental illness and substance use disorders. Community Mental Health Journal1994; 30:145–163.
25.
ClarkR.Family costs associated with severe mental illness and substance use. Hospital and Community Psychiatry1994; 45:808–813.
