Home-based versus hospital-based care for serious mental illness. Controlled cost-effectiveness study over four years.
BACKGROUND
The Daily Living Programme (DLP) offered intensive home-based care with problem-centred case management for seriously mentally ill people facing crisis admission to the Maudsley Hospital, London. The cost-effectiveness of the DLP was examined over four years.


METHODS
A randomised controlled study examined cost-effectiveness of DLP versus standard in/out-patient hospital care over 20 months, followed by a randomised controlled withdrawal of half the DLP patients into standard care. Three patient groups were compared over 45 months: DLP throughout the period, DLP for 20 months followed by standard care, and standard care throughout. Bivariate and multivariate analyses were conducted (the latter to standardise for possible inter-sample differences stemming from sample attrition and to explore sources of within-sample variation).


RESULTS
The DLP was more cost-effective than control care over months 1-20, and also over the full 45-month period, but the difference between groups may have disappeared by the end of month 45.


CONCLUSIONS
The reduction of the cost-effectiveness advantage for home-based care was perhaps partly due to the attenuation of DLP care, although sample attrition left some comparisons under-powered.
Knapp
M
M
Institute of Psychiatry, Centre for the Economics of Mental Health, London, UK.
Marks
I
I
Wolstenholme
J
J
Beecham
J
J
Astin
J
J
Audini
B
B
Connolly
J
J
Watts
V
V
D000293:Adolescent; D000328:Adult; D003156:Community Mental Health Services / Q000191:economics / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D004651:Employment; D005192:Family Health; D005260:Female; D017048:Health Care Costs; D006699:Home Care Services / Q000191:economics*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008131:London; D008297:Male; D001523:Mental Disorders / Q000191:economics* / Q000628:therapy; D008875:Middle Aged