Economic evaluation of a crisis resolution service: A randomised controlled trial

Abstract

Aims -The use of specialised services to avoid admission to hospital for people experiencing mental health crises is seen as an integral part of psychiatric services in some countries. The aim of this paper is to assess the impact on costs and costeffectiveness of a crisis resolution team (CRT). Methods -Patients who were experiencing mental health crises sufficient for admission to be considered were randomised to either care provided by a CRT or standard services. The primary outcome measure was inpatient days over a six-month follow-up period. Service use was measured, costs calculated and cost-effectiveness assessed. Results -Patients receiving care from the CRT had non-inpatient costs £768 higher than patients receiving standard care (90% CI, £153 to £1375). With the inclusion of inpatient costs the costs for the CRT group were £2438 lower for the CRT group (90% CI, £937 to £3922). If one less day spent as an inpatient was valued at £100, there would be a 99.5% likelihood of the CRT being costeffective. Conclusion -This CRT was shown to be cost-effective for modest values placed on reductions in inpatient stays.Declaration of Interest: No authors have any interests to declare.

“Risky Business”: a critical analysis of the role of crisis resolution and home treatment teams

“…Barker et al, 2011) and lower service costs (e.g. McCrone et al, 2009). However, the evidence is patchy, and other studies report increased compulsory admissions and little or no effect on bed usage (e.g.…”

Crisis teams: systematic review of their effectiveness in practice

“…One of these 36 re-analysed previously reported RCT data, 9 three were 'pre-and post-CRT comparisons', 26,27,37 one compared police and crisis handling of psychiatric emergencies, 30 and one was a national audit using a decision model. 38 Overall, as might be expected, the CRTs were less expensive than in-patient care, although no statistical testing was reported in some work.…”

“…36 In the prospective controlled trial 37 the finding that a CRT patient costs less per 6 months than an in-patient was only significant when patients who had any CRT contact were compared with those that had no contact, rather than comparing pre-or post-CRT groups.…”

Health economic evaluation of community-based psychiatric interventions

“…Auch in den letzten Jahren liegt der Schwerpunkt gesundheitsökonomischer Analysen überwiegend in der Bewertung spezifischer gemeindepsychiatrischer Behandlungsformen, insbesondere auf der Basis des ACT-Ansatzes [5,24,39,40], aber auch zur Krisenintervention [9,23] und zur Frühintervention bei Psychoseerkrankungen [22,25]. Aktuelle Studien zur Kosteneffektivität von ACT-Programmen in Großbritannien [4,23,24], Polen [39], Georgien [40] und den USA [5] zeigen, dass diese im Vergleich zur Routinebehandlung in der Regel zu einer Erhöhung der ambulanten psychiatrischen Versorgungskosten führen und dass diese höheren ambulanten Kosten nur dann durch eine gleichzeitige Reduzierung stationärer Behandlungskosten ausgeglichen werden ("cost offset"), wenn es sich bei der Untersuchungspopulation um Patienten mit einem besonders hohen Hospitalisierungsrisiko handelt, wie z.…”

“…Aktuelle Studien zur Kosteneffektivität von ACT-Programmen in Großbritannien [4,23,24], Polen [39], Georgien [40] und den USA [5] zeigen, dass diese im Vergleich zur Routinebehandlung in der Regel zu einer Erhöhung der ambulanten psychiatrischen Versorgungskosten führen und dass diese höheren ambulanten Kosten nur dann durch eine gleichzeitige Reduzierung stationärer Behandlungskosten ausgeglichen werden ("cost offset"), wenn es sich bei der Untersuchungspopulation um Patienten mit einem besonders hohen Hospitalisierungsrisiko handelt, wie z. B. im Fall der von Cusack et al [5] untersuchten psychisch kranken Straftäter.…”