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Home-based versus hospital-based care for serious mental illness: Controlled cost-effectiveness study over four years

  • Martin R. J. Knapp (a1), Isaac M. Marks (a2), Jane Wolstenholme (a3), Jennifer K. Beecham (a4), Jack Astin (a4), Bernard Audini (a5), Joseph Connolly (a6) and Vik Watts (a7)...



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.


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).


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.


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.


Corresponding author

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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Home-based versus hospital-based care for serious mental illness: Controlled cost-effectiveness study over four years

  • Martin R. J. Knapp (a1), Isaac M. Marks (a2), Jane Wolstenholme (a3), Jennifer K. Beecham (a4), Jack Astin (a4), Bernard Audini (a5), Joseph Connolly (a6) and Vik Watts (a7)...
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