Joint crisis plans for people with psychosis: economic evaluation of a randomised controlled trial

Abstract

Objective To investigate the cost effectiveness of joint crisis plans, a form of advance agreement for people with severe mental illness. Design Single blind randomised controlled trial. Setting Eight community mental health teams in southern England. Participants 160 people with a diagnosis of psychotic illness or non-psychotic bipolar disorder who had been admitted to hospital at least once within the previous two years. Intervention Joint crisis plan formulated by the patient, care coordinator, psychiatrist, and project worker containing contact information, details of illnesses, treatments, relapse indicators, and advance statements of preferences for care for future relapses. Control group was standardised service information. Main outcome measures Admission to hospital; service use over 15 months. Results Use of a joint crisis plan was associated with less service use and lower costs on average than in the standardised service information group, but differences were not significant. Total costs during follow-up were £7264 (€10 616, $13 560) for each participant with a joint crisis plan and £8359 (€12 217, $15 609) for each participant with standardised service information (mean difference £1095; 95% confidence interval − 2814 to 5004). Cost effectiveness acceptability curves, used to explore uncertainty in estimates of costs and effects, suggest there is a greater than 78% probability that joint crisis plans are more cost effective than standardised service information in reducing the proportion of patients admitted to hospital. Conclusion Joint crisis plans produced a non-significant decrease in admissions and total costs. Though the cost estimates had wide confidence intervals, the associated uncertainty suggests there is a relatively high probability of the plans being more cost effective than standardised service information for people with psychotic disorders.

Economic Aspects of Peer Support Groups for Psychosis

“…Mean total costs of healthcare utilisation during the 8 months of the study were approximately €5,750 for both groups, after correcting for initial cost differences between groups. These total costs are comparable with healthcare costs assessed in previous studies in patients with psychosis or schizophrenia (Flood et al 2006;Knapp et al 2002). Hospitalisation costs can have a large impact on the total amount of costs in the area of mental healthcare.…”

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.…”

Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach

“…[292][293][294][295][296] However, there have been very few studies that have explored recovery experiences systematically in BD. Some qualitative studies have explored how individuals with BD stay well, focusing primarily on methods by which relapse is avoided, rather than on the subjective process of recovery, highlighting the importance of both medication and psychosocial support in the context of active condition management by the individual.…”