Cost-effectiveness of intensive home treatment enhanced by inpatient treatment elements in child and adolescent psychiatry in Germany: A randomised trial.
BACKGROUND
Admission rate to child and adolescent mental health inpatient units in Germany is high (54,467 admissions in 2013), resources for providing necessary beds are scarce. Alternative pathways to care are needed. Objective of this study was to assess the cost-effectiveness of inpatient treatment versus Hot-BITs-treatment (Hometreatment brings inpatient-treatment outside), a new supported discharge service offering an early discharge followed by 12 weeks of intensive support.


METHODS
Of 164 consecutively recruited children and adolescents, living within families and being in need of inpatient mental health care, 100 patients consented to participate and were randomised via a computer-list into intervention (n=54) and control groups (n=46). Follow-up data were available for 76 patients. Primary outcome was cost-effectiveness. Effectiveness was gathered by therapist-ratings on the Children's Global Assessment Scale (CGAS) at baseline (T1), treatment completion (T2) and an 8-month-follow-up (T3). Cost of service use (health care costs and non-health care costs) was calculated on an intention-to-treat basis at T2 and T3.


RESULTS
Significant treatment effects were observed for both groups between T1/T2 and T1/T3 (P<0.001). The Hot-BITs treatment, however, was associated with significantly lower costs at T2 (difference: -6900.47€, P=0.013) and T3 (difference: -8584.10€, P=0.007). Bootstrap cost-effectiveness ratio indicated that Hot-BITs was less costly and tended to be more effective at T2 and T3.


CONCLUSIONS
Hot-BITs may be a feasible cost-effective alternative to long inpatient stays in child and adolescent psychiatry. Further rigorous evaluations of the model are required. (


BACKGROUND
ISRCTN02672532, part 1, Current Controlled Trials Ltd, URL: http://www.controlled-trials.com).
ZfP Suedwuerttemberg, Child and Adolescent Psychiatry, Weingartshoferstrasse 2, 88214 Ravensburg, Germany; University of Ulm, Department of Child and Adolescent Psychiatry, Ulm, Germany. Electronic address: Isabel.Boege@zfp-zentrum.de.
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Boege
ZfP Suedwuerttemberg, Child and Adolescent Psychiatry, Weingartshoferstrasse 2, 88214 Ravensburg, Germany.
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Corpus
University of Ulm, Department of Child and Adolescent Psychiatry, Ulm, Germany.
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Schepker
University of Ulm, Psychiatry II, BKH Günzburg, Günzburg, Germany.
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Kilian
University of Ulm, Department of Child and Adolescent Psychiatry, Ulm, Germany.
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JM
Fegert
D000293:Adolescent; D000296:Adolescent Psychiatry; D002648:Child; D002653:Child Behavior Disorders / Q000191:economics* / Q000628:therapy*; D003156:Community Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D005260:Female; D005858:Germany; D017048:Health Care Costs; D006699:Home Care Services / Q000191:economics* / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D010351:Patient Discharge / Q000191:economics
Community programs; Economic evaluation; Liaison child psychiatry; Quality of life; Service development