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Home-based versus hospital-based care for serious mental illness

Controlled cost-effectiveness study over four years

Published online by Cambridge University Press:  03 January 2018

Martin R. J. Knapp ,
Isaac M. Marks ,
Jane Wolstenholme ,
Jennifer K. Beecham ,
Jack Astin ,
Bernard Audini ,
Joseph Connolly  and
Vik Watts
Martin R. J. Knapp*
Affiliation:
Institute of Psychiatry, and London School of Economics
Isaac M. Marks
Affiliation:
Institute of Psychiatry and Bethlem – Maudsley Hospital
Jane Wolstenholme
Affiliation:
University of Nottingham
Jennifer K. Beecham
Affiliation:
Institute of Psychiatry
Jack Astin
Affiliation:
Institute of Psychiatry
Bernard Audini
Affiliation:
Royal College of Psychiatrists
Joseph Connolly
Affiliation:
Formerly Bethlem – Maudsley Hospital
Vik Watts
Affiliation:
Enfield Community Care Trust
*
Professor Martin Knapp, Centre for the Economics of Mental Health, Institute of Psychiatry, 7 Windsor Walk, Denmark Hill, London SE5 8BB, UK
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Abstract

Background

The Daily Living Programme (DLP) offered intensive home-based care with problem-centred case management for seriously mentally ill people facing crisis admission to the Maudsley Hospital, London. The cost-effectiveness of the DLP was examined over four years.

Method

A randomised controlled study examined cost-effectiveness of DLP versus standard in/out-patient hospital care over 20 months, followed by a randomised controlled withdrawal of half the DLP patients into standard care. Three patient groups were compared over 45 months: DLP throughout the period, DLP for 20 months followed by standard care, and standard care throughout. Bivariate and multivariate analyses were conducted (the latter to standardise for possible inter-sample differences stemming from sample attrition and to explore sources of within-sample variation).

Results

The DLP was more cost-effective than control care over months 1–20, and also over the full 45-month period, but the difference between groups may have disappeared by the end of month 45.

Conclusions

The reduction of the cost-effectiveness advantage for home-based care was perhaps partly due to the attenuation of DLP care, although sample attrition left some comparisons under-powered.

Type
Papers
Information
The British Journal of Psychiatry , Volume 172 , Issue 6 , June 1998 , pp. 506 - 512
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

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