title: Costs of a public health model to increase receipt of hepatitis-related services for persons with mental illness.
abstract: OBJECTIVE
  This study examined the costs and impact on receipt of hepatitis and HIV testing and hepatitis immunization services of a public health intervention model that was designed for use by persons with serious mental illness and co-occurring substance use disorders.
  
  
  METHODS
  Between 2006 and 2008, a random sample of 202 nonelderly, predominantly African-American males with a psychotic or major depressive disorder and a co-occurring substance use disorder was recruited at four community mental health outpatient programs in a large metropolitan area. Participants were randomly assigned at each site to enhanced treatment as usual (N=97), including education about blood-borne diseases and referrals for testing and vaccinations, or to an experimental intervention (N=105) that provided on-site infectious disease education, screening of risk level, pretest counseling, testing for HIV and hepatitis B and C, vaccination for hepatitis A and B, and personalized risk-reduction counseling. The authors compared the two study groups to assess the average costs of improving hepatitis and HIV testing and hepatitis A and B vaccination in this population.
  
  
  RESULTS
  The average cost per participant was $423 for the intervention and $24 for the comparison condition (t=52.7, df=201, p<.001). The costs per additional person tested was $706 for hepatitis C, $776 for hepatitis B, and $3,630 for HIV, and the cost per additional person vaccinated for hepatitis was $561.
  
  
  CONCLUSIONS
  Delivery of hepatitis and HIV public health services to persons with serious mental illness in outpatient mental health settings can be as cost-effective as similar interventions for other at-risk populations.
authors.affiliation: Veterans Affairs CapitolHealth Care Network (Veterans Integrated Service Network), Mental Illness Research, Education and Clinical Center, Baltimore, MD, USA. eslade@psych.umaryland.edu
authors.forename: Eric P
authors.initials: EP
authors.lastname: Slade
authors.forename: Stanley
authors.initials: S
authors.lastname: Rosenberg
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Dixon
authors.forename: Richard W
authors.initials: RW
authors.lastname: Goldberg
authors.forename: George L
authors.initials: GL
authors.lastname: Wolford
authors.forename: Seth
authors.initials: S
authors.lastname: Himelhoch
authors.forename: Stephanie
authors.initials: S
authors.lastname: Tapscott
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000458:organization & administration; D003156:Community Mental Health Services / Q000191:economics*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics; D003695:Delivery of Health Care / Q000191:economics*; D017831:Diagnosis, Dual (Psychiatry); D015658:HIV Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D006525:Hepatitis, Viral, Human / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics*; D001523:Mental Disorders / Q000191:economics* / Q000453:epidemiology; D008875:Middle Aged; D010353:Patient Education as Topic / Q000191:economics; D015397:Program Evaluation / Q000191:economics; D014505:Urban Population; D014611:Vaccination / Q000191:economics*; D055815:Young Adult