Long-term mental health resource utilization and cost of care following group psychoeducation or unstructured group support for bipolar disorders: a cost-benefit analysis.
OBJECTIVE
To explore the short- and long-term mental health resource utilization and cost of care in a sample of 120 individuals with bipolar disorders who participated in a randomized controlled efficacy trial of group psychoeducation versus unstructured group support.


METHODS
Prospective, independent monitoring of DSM-IV bipolar disorder type I or II patients aged 18 to 65 years was conducted during the intervention phase (6 months) and follow-up phase (5-year postintervention) of a randomized controlled trial reporting clinical outcomes and inpatient and outpatient mental health service utilization, with estimation of cost of treatment per patient. The study was conducted from October 1997 through October 2006.


RESULTS
Compared with individuals with bipolar disorder receiving the control intervention, psychoeducated patients had twice as many planned outpatient appointments, but the estimated mean cost of emergency consultation utilization was significantly less. There were trends for psychoeducated patients to opt for self-funded psychotherapy after completing group psychoeducation and to utilize more medications. However, inpatient care accounted for 40% estimated total cost in the control group but only about 15% in the psychoeducation group.


CONCLUSIONS
This study demonstrates the importance of taking a long-term overview of the cost versus benefits of adjunctive psychological therapy in bipolar disorders. If viewed only in the short-term, the psychoeducation group used more mental health care resources without clear additional health gain. However, extended follow-up demonstrated a long-term advantage for psychoeducated individuals, such that, compared to an unstructured support group intervention, group psychoeducation is less costly and more effective.
Scott
Jan
J
Royal Victoria Infirmary, University of Newcastle upon Tyne, and Institute of Psychiatry, London, United Kingdom.
Colom
Francesc
F
Popova
Ekaterina
E
Benabarre
Antonio
A
Cruz
Nuria
N
Valenti
Marc
M
Goikolea
José M
JM
Sánchez-Moreno
Jose
J
Asenjo
Miguel A
MA
Vieta
Eduard
E
D000328:Adult; D000927:Anticonvulsants / Q000191:economics / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use; D018692:Antimanic Agents / Q000191:economics / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000191:economics / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D003131:Combined Modality Therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics* / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000191:economics*; D011615:Psychotherapy, Group / Q000191:economics*; D016032:Randomized Controlled Trials as Topic; D016037:Single-Blind Method; D013030:Spain; D014600:Utilization Review / Q000706:statistics & numerical data; D055815:Young Adult
D000927:Anticonvulsants; D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents