Abstract
Objective
To compare cost‐effectiveness of integrated care with therapeutic assertive community treatment (IC‐TACT) versus standard care (SC) in multiple episode psychosis.
Method
12‐month IC‐TACT in patients with schizophrenia‐spectrum and bipolar I disorders were compared with a historical control group. Primary outcomes were entropy‐balanced cost‐effectiveness based on mental health care costs from a payers’ perspective and quality‐adjusted life years (QALYs) as a measure of health effects during 12‐month follow‐up.
Results
At baseline, patients in IC‐TACT (n=214) had significantly higher illness severity and lower functioning than SC (n=56). Over 12 months, IC‐TACT had significantly lower days in inpatient (10.3±20.5 vs. 28.2±44.9; p=0.005) and day‐clinic care (2.6±16.7 vs. 16.4±33.7; p=.004) and correspondingly lower costs (€‐55,084). Within outpatient care, IC‐TACT displayed a higher number of treatment contacts (116.3±45.3 vs. 15.6±6.3) and higher related costs (€+1,417). Both resulted in lower total costs in IC‐TACT (mean difference=€‐13,248±2,975, p<0.001). Adjusted incremental QALYs were significantly higher for IC‐TACT versus SC (+0.10±0.37, p=0.05). The probability of cost‐effectiveness of IC‐TACT was constantly higher than 99%.
Conclusion
IC‐TACT was cost‐effective compared with SC. The use of prima facies ‘costly’ TACT teams is highly recommended to improve outcomes and save total cost for patients with severe psychotic disorders.