Cost-effectiveness of home treatment compared to inpatient care in child and adolescent psychiatry: evidence from a pilot trial.
Mental disorders in children and adolescents have increased substantially, placing growing pressure on healthcare systems. Home treatment has emerged as an alternative to conventional inpatient treatment as usual (I-TAU), potentially offering clinical and cost benefits. This study aimed to evaluate the cost-effectiveness of an intensive home treatment programme (AT_HOME) compared to I-TAU in Switzerland.
Data were collected within a monocentric pilot trial involving 75 children and adolescents (aged 6-17 years) admitted for acute psychiatric care between May 2019 and July 2020. Participants were allocated to AT_HOME if they met geographical and safety criteria and consented to receive home treatment (n = 27); all remaining patients received I-TAU (n = 48). Clinical effectiveness was assessed as between-group differences in change in psychosocial functioning from admission to follow-up at 18-24 months, assessed with the Global Assessment of Functioning (GAF) scale. The primary outcome of this secondary analysis was the cost-effectiveness of home treatment compared with I-TAU. Cost estimates included direct medical costs for the initial treatment period and follow-up healthcare utilisation from a comprehensive multi-payer healthcare system perspective. Cost-effectiveness was analysed using incremental cost-effectiveness ratios (ICER) and cost-effectiveness acceptability curves (CEAC). Secondary outcomes included the costs of the index treatment, costs of follow-up mental healthcare utilisation and total costs.
The point estimate of the incremental cost of home treatment compared to I-TAU was CHF -48,591 (95% CI: -108,493 to 11,312; SE: 30,563) and the incremental effect was 9.41 (95% CI: 0.52 to 18.31; SE: 4.54) on the GAF scale. The resulting ICER was -5161 per 1-point improvement in the GAF score (95% CI: - 49,482 to 39,161; SE: 22,613) and the CEAC suggested a high probability (94.6%) that home treatment was cost-effective compared with I-TAU across willingness-to-pay thresholds.
In this pilot trial, home treatment for children and adolescents with severe psychiatric disorders was associated with favourable cost-effectiveness estimates compared with I-TAU. These findings suggest that intensive home-based treatment models may have the potential to contribute to more efficient use of mental health resources.
DRKS00025424 (German Clinical Trials Register, registered on 27 May 2021).
Data were collected within a monocentric pilot trial involving 75 children and adolescents (aged 6-17 years) admitted for acute psychiatric care between May 2019 and July 2020. Participants were allocated to AT_HOME if they met geographical and safety criteria and consented to receive home treatment (n = 27); all remaining patients received I-TAU (n = 48). Clinical effectiveness was assessed as between-group differences in change in psychosocial functioning from admission to follow-up at 18-24 months, assessed with the Global Assessment of Functioning (GAF) scale. The primary outcome of this secondary analysis was the cost-effectiveness of home treatment compared with I-TAU. Cost estimates included direct medical costs for the initial treatment period and follow-up healthcare utilisation from a comprehensive multi-payer healthcare system perspective. Cost-effectiveness was analysed using incremental cost-effectiveness ratios (ICER) and cost-effectiveness acceptability curves (CEAC). Secondary outcomes included the costs of the index treatment, costs of follow-up mental healthcare utilisation and total costs.
The point estimate of the incremental cost of home treatment compared to I-TAU was CHF -48,591 (95% CI: -108,493 to 11,312; SE: 30,563) and the incremental effect was 9.41 (95% CI: 0.52 to 18.31; SE: 4.54) on the GAF scale. The resulting ICER was -5161 per 1-point improvement in the GAF score (95% CI: - 49,482 to 39,161; SE: 22,613) and the CEAC suggested a high probability (94.6%) that home treatment was cost-effective compared with I-TAU across willingness-to-pay thresholds.
In this pilot trial, home treatment for children and adolescents with severe psychiatric disorders was associated with favourable cost-effectiveness estimates compared with I-TAU. These findings suggest that intensive home-based treatment models may have the potential to contribute to more efficient use of mental health resources.
DRKS00025424 (German Clinical Trials Register, registered on 27 May 2021).
Authors
Graf Graf, Sele Sele, Reichl Reichl, Oberli Oberli, Blankart Blankart, Ammann Ammann, Kaess Kaess
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