Intensive case management: a cost-effectiveness analysis.
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.


METHODS
A cost-effectiveness analysis was conducted alongside a randomised controlled trial. Seventy-three patients, who reside in the eastern suburbs of Sydney, were randomly allocated to either intensive or routine case management. Staff providing intensive case management and substantially lower caseloads than staff providing routine case management. The main health outcome measured was patients' level of functioning as measured by the Life Skills Profile. Costing data were collected 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 (chi 2 = 6.00, df = 1, p < 0.01) and showed a clinically significant improvement in functioning from baseline to 12 months (chi 2 = 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.


CONCLUSIONS
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.
Susan Johnston Consultancy Services, Leichhardt, New South Wales, Australia. sgjohns@ozemail.com.au
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Johnston
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Salkeld
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Sanderson
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Issakidis
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Teesson
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Buhrich
D000293:Adolescent; D000328:Adult; D000368:Aged; D019090:Case Management / Q000191:economics* / Q000592:standards; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D003858:Dependency, Psychological; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000191:economics* / Q000628:therapy; D008605:Mental Health Services / Q000191:economics* / Q000592:standards; D008875:Middle Aged; D009517:New South Wales; D010043:Outcome and Process Assessment, Health Care; D010561:Personnel Staffing and Scheduling / Q000191:economics / Q000706:statistics & numerical data; D018709:Statistics, Nonparametric; D016526:Workload / Q000191:economics