title: Cost-effectiveness of intensive v. standard case management for severe psychotic illness. UK700 case management trial. UK700 Group.
abstract: BACKGROUND
  Intensive case management is commonly advocated for the care of the severely mentally ill, but evidence of its cost-effectiveness is lacking.
  
  
  OBJECTIVE
  To investigate the cost-effectiveness of intensive compared with standard case management for patients with severe psychosis.
  
  
  METHODS
  708 patients with psychosis and a history of repeated hospital admissions were randomly allocated to standard (case-loads 30-35) or intensive (case-loads 10-15) case management. Clinical and resource use data were assessed over two years.
  
  
  RESULTS
  No statistically significant difference was found between intensive and standard case management in the total two-year costs of care per patient (means 24,550 Pounds and 22,700 Pounds, respectively, difference 1850 Pounds, 95% CI--1600 Pounds to 5300 Pounds). There was no evidence of differential effects in African-Caribbean patients or in the most disabled. Psychiatric in-patient hospital stay accounted for 47% of the total costs, but neither such hospitalisation nor other clinical outcomes differed between the randomised groups.
  
  
  CONCLUSIONS
  Reduced case-loads have no clear beneficial effect on costs, clinical outcome or cost-effectiveness. The policy of advocating intensive case management for patients with severe psychosis is not supported by these results.
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics*; D005500:Follow-Up Studies; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008875:Middle Aged; D011618:Psychotic Disorders / Q000191:economics* / Q000208:ethnology / Q000628:therapy; D016896:Treatment Outcome; D014900:West Indies / Q000453:epidemiology