The REACT study: cost-effectiveness analysis of assertive community treatment in north London.
OBJECTIVE
Assertive community treatment (ACT) is a key component of mental health care, but recent information on its cost-effectiveness is limited. This article provides a cost-effectiveness analysis of assertive community treatment and usual care from community mental health teams (CMHTs) in the United Kingdom.


METHODS
Participants who had difficulties engaging with community services were randomly assigned to ACT (N=127) or continued usual care from CMHTs (N= 124). Costs were measured at baseline and 18 months later and compared between the two groups. In the analysis, cost data were linked to information on satisfaction, which had been shown to be significantly higher with ACT.


RESULTS
Total follow-up costs over 18 months were higher for the ACT group by pounds sterling 4,031 ($6,369), but this was not statistically significant (95% confidence interval of - pounds sterling 2,592 to pounds sterling 10,690 [-$4,095 to $16,890]). A one-unit improvement in satisfaction was associated with extra costs in the ACT group of pounds sterling 473 ($747).


CONCLUSIONS
The costs of ACT were not significantly different from usual care. ACT did, however, result in greater levels of client satisfaction and engagement with services and as such may be the preferred community treatment option for patients with long-term serious mental health problems.
McCrone
Paul
P
Health Services and Population Research Department, King's College London, PO24 Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. paul.mccrone@kcl.ac.uk
Killaspy
Helen
H
Bebbington
Paul
P
Johnson
Sonia
S
Nolan
Fiona
F
Pilling
Stephen
S
King
Michael
M
D000328:Adult; D001714:Bipolar Disorder / Q000191:economics / Q000534:rehabilitation; D019090:Case Management / Q000191:economics*; D003156:Community Mental Health Services / Q000191:economics*; D003362:Cost-Benefit Analysis; D003865:Major Depressive Disorder / Q000191:economics / Q000534:rehabilitation; D005260:Female; D006801:Humans; D008131:London; D008297:Male; D001523:Mental Disorders / Q000191:economics* / Q000534:rehabilitation*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000191:economics; D017060:Patient Satisfaction / Q000191:economics; D011618:Psychotic Disorders / Q000191:economics / Q000534:rehabilitation; D012559:Schizophrenia / Q000191:economics / Q000534:rehabilitation; D012563:Schizophrenia, Paranoid / Q000191:economics / Q000534:rehabilitation; D013222:State Medicine / Q000191:economics*