Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-07T20:36:09.415Z Has data issue: false hasContentIssue false
  • English
  • Français

Economic evaluation of a crisis resolution service: A randomised controlled trial

Published online by Cambridge University Press:  11 April 2011

Paul McCrone ,
Sonia Johnson ,
Fiona Nolan ,
Stephen Pilling ,
Andrew Sandor ,
John Hoult ,
Nigel McKenzie ,
Marie Thompson  and
Paul Bebbington
Paul McCrone*
Affiliation:
Health Service and Population Research Department, Institute of Psychiatry, King's College London (United Kingdom)
Sonia Johnson
Affiliation:
Department of Mental Health Sciences, Royal Free and University College Medical Schools, University College London (United Kingdom)
Fiona Nolan
Affiliation:
Camden and Islington Mental Health and Social Care Trust, London (United Kingdom)
Stephen Pilling
Affiliation:
CORE (British Psychological Psychology), Sub-Department of Clinical Health Psychology, University College London (United Kingdom)
Andrew Sandor
Affiliation:
Central and North West London Mental Health NHS Trust, London (United Kingdom)
John Hoult
Affiliation:
Camden and Islington Mental Health and Social Care Trust, London (United Kingdom)
Nigel McKenzie
Affiliation:
Camden and Islington Mental Health and Social Care Trust, London (United Kingdom)
Marie Thompson
Affiliation:
Department of Clinical Psychology, University of Surrey, Guildford (United Kingdom)
Paul Bebbington
Affiliation:
Department of Mental Health Sciences, Royal Free and University College Medical Schools, University College London (United Kingdom)
*
Address for correspondece: Dr. P. McCrone, P024 Health Service and Population Research Department, Institute of Psychiatry, De Crespigny Park, London SE5 8AF (United Kingdom). E-mail:p.mccrone@iop.kcl.ac.uk
Get access Rights & Permissions [Opens in a new window]

Summary

Aims – The use of specialised services to avoid admission to hospital for people experiencing mental health crises is seen as an integral part of psychiatric services in some countries. The aim of this paper is to assess the impact on costs and costeffectiveness of a crisis resolution team (CRT). Methods – Patients who were experiencing mental health crises sufficient for admission to be considered were randomised to either care provided by a CRT or standard services. The primary outcome measure was inpatient days over a six-month follow-up period. Service use was measured, costs calculated and cost-effectiveness assessed. Results – Patients receiving care from the CRT had non-inpatient costs £768 higher than patients receiving standard care (90% CI, £153 to £1375). With the inclusion of inpatient costs the costs for the CRT group were £2438 lower for the CRT group (90% CI, £937 to £3922). If one less day spent as an inpatient was valued at £100, there would be a 99.5% likelihood of the CRT being costeffective. Conclusion – This CRT was shown to be cost-effective for modest values placed on reductions in inpatient stays.

Keywords

costs and cost analysiscommunity mental health servicescrisis interventioneconomics
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 18 , Issue 1 , March 2009 , pp. 54 - 58
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Beecham, J. & Knapp, M. (2001). Costing psychiatric interventions. In Measuring Mental Health Needs. 2nd ed. (ed. G., Thornicroft), pp. 200–224. Gaskell: London.Google Scholar
Curtis, L. & Netten, A. (2004). Unit Costs of Health and Social Care. Personal Social Services Research Unit, University of Kent: Canterbury.Google Scholar
Department of Health (2001). Mental Health Policy Implementation Guide. Department of Health: London.Google Scholar
Durham University (2004). Adult Mental Health Service Mapping. Retrieved August 6, 2008, from http://www.amhmapping.org.uk/reports/live.phpGoogle Scholar
Johnson, S. (2004). Crisis resolution and home treatment teams. Psychiatry 3, 22–25.CrossRefGoogle Scholar
Johnson, S., Nolan, F., Pilling, S., Sandor, A., Hoult, J., McKenzie, N., White, I.R., Thompson, M. & Bebbington, P. (2005). Randomised controlled trial of acute mental health care by a specialist crisis team: the north Islington crisis study. British Medical Journal 331, 599–602.CrossRefGoogle Scholar
Killaspy, H., Bebbington, P., Blizard, R., Johnson, S., Nolan, F., Pilling, S. & King, M. (2006). The REACT study: Randomised evaluation of assertive community treatment in north London. British Medical Journal 332, 815–820.CrossRefGoogle ScholarPubMed
Killaspy, H., Johnson, S., King, M. & Bebbington, P. (2008). Developing mental health services in response to research evidence. Epidemiologia e Psichiatria Sociale 17, 47–56.CrossRefGoogle ScholarPubMed
McCrone, P., Ridsdale, L., Darbishire, L. & Seed, P. (2004). Cost-effectiveness of cognitive behavioural therapy, graded exercise and usual care for patients with chronic fatigue in primary care. Psychological Medicine 34, 991–999.CrossRefGoogle ScholarPubMed
Netten, A. & Curtis, L. (2002). Unit Costs of Health and Social Care. Personal Social Services Research Unit, University of Kent: Canterbury.Google Scholar
Priebe, S., Huxley, P., Knight, S. & Evans, S. (1999). Application and results of the Manchester short assessment of quality of life. International Journal of Social Psychiatry 45, 7–12.CrossRefGoogle ScholarPubMed
Smyth, M.G. & Hoult, J. (2000). The home treatment enigma. British Medical Journal 320, 305–308.CrossRefGoogle ScholarPubMed
Wing, J.K., Beevor, A.S., Curtis, R.H., Park, S.B., Hadden, S. & Burns, A. (1998). Health of the Nation Outcomes Scales (HoNOS). Research and Development. British Journal of Psychiatry 172, 11–18.CrossRefGoogle ScholarPubMed