title: Cost-effectiveness of 12-month therapeutic assertive community treatment as part of integrated care versus standard care in patients with schizophrenia treated with quetiapine immediate release (ACCESS trial).
abstract: OBJECTIVE
  To compare the 1-year cost-effectiveness of therapeutic assertive community treatment (ACT) with standard care in schizophrenia. ACT was specifically developed for patients with schizophrenia, delivered by psychosis experts highly trained in respective psychotherapies, and embedded into an integrated care system.
  
  
  METHODS
  Two catchment areas in Hamburg, Germany, with similar population size and health care structures were assigned to offer 12-month ACT (n = 64) or standard care (n = 56) to 120 first- and multiple-episode patients with schizophrenia spectrum disorders (DSM-IV), the latter with a history of relapse due to medication nonadherence. Primary outcome was the incremental cost-effectiveness ratio (ICER) based on mental health care costs from a payer perspective and quality-adjusted life-years (QALYs) as a measure of health effects during the 12-month follow-up period (2006-2007).
  
  
  RESULTS
  ACT was associated with significantly lower inpatient but higher outpatient costs than standard care, resulting in nonsignificantly lower total costs (P = .27). Incremental QALYs in the ACT group were 0.1 (P < .001). Thus, the point estimate for the ICER showed dominance of ACT. The probability of an ICER below 50,000 per QALY gained was 99.5%.
  
  
  CONCLUSIONS
  The implementation of a psychotherapeutically oriented schizophrenia-specific and -experienced ACT team led to an improved patient outcome with reduced need of inpatient care. Despite the introduction of such a rather "costly" ACT team, treatment in ACT was cost-effective with regard to improved quality of life at comparable yearly costs.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT01081418.
authors.affiliation: Department of Psychiatry and Psychotherapy, Psychosis Centre, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Germany. karow@uke.de
authors.forename: Anne
authors.initials: A
authors.lastname: Karow
authors.forename: Jens
authors.initials: J
authors.lastname: Reimer
authors.forename: Hans Helmut
authors.initials: HH
authors.lastname: König
authors.forename: Dirk
authors.initials: D
authors.lastname: Heider
authors.forename: Thomas
authors.initials: T
authors.lastname: Bock
authors.forename: Christian
authors.initials: C
authors.lastname: Huber
authors.forename: Daniel
authors.initials: D
authors.lastname: Schöttle
authors.forename: Klara
authors.initials: K
authors.lastname: Meister
authors.forename: Liz
authors.initials: L
authors.lastname: Rietschel
authors.forename: Gunda
authors.initials: G
authors.lastname: Ohm
authors.forename: Holger
authors.initials: H
authors.lastname: Schulz
authors.forename: Dieter
authors.initials: D
authors.lastname: Naber
authors.forename: Benno G
authors.initials: BG
authors.lastname: Schimmelmann
authors.forename: Martin
authors.initials: M
authors.lastname: Lambert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data*; D003987:Dibenzothiazepines / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D011613:Psychotherapy / Q000191:economics* / Q000379:methods; D000069348:Quetiapine Fumarate; D012559:Schizophrenia / Q000188:drug therapy / Q000191:economics* / Q000628:therapy
chemical_list: D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D000069348:Quetiapine Fumarate