Skip to main content Accessibility help
×
Home

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)...

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.

Copyright

Corresponding author

Professor Martin Knapp, Centre for the Economics of Mental Health, Institute of Psychiatry, 7 Windsor Walk, Denmark Hill, London SE5 8BB, UK

References

Hide All
Atkinon, C. C. & Zwick, R. (1985) The Client Satisfaction Questionnaire: psychometric properties and correlation with service utilization and psychotherapy outcome. Evaluation and Program Planning, 5, 233237.
Audlni, B. Marks, I. M. Lawrence, R. E. et al (1994) Home-based versus out-patient/in-patient care for people with serious mental illness. British Journal of Psychiatry, 165, 204210.
Beecham, J. K. (1995) Collecting and estimating costs. In The Economic Evaluation of Mental Health Care (ed. M. R. J. Knapp), pp. 6182, Aldershot: Arena.
Beecham, J. K. & Knapp, M. R. J. (1992) Costing psychiatric options. In Measuring Mental Health Needs (eds G. Thornicroft, C. Brewin & J. Wing), pp. 170190, Oxford: Oxford University Press.
Bond, G. R. McGrew, J. H. & Fekete, D. M. (1995) Assertive outreach for frequent users of psychiatric hospital; a meta-analysis. Journal of Mental Health Administration, 22, 416.
Burns, B. J. & Santos, A. B. (1995) Assertive community treatment: an update of randomized trials. Psychiatric Services, 46, 669675.
Connolly, J. Marks, I. M. Lawrence, R. et al (1996) Observations from community care for serious mental illness during a controlled trial. Psychiatric Bulletin, 20, 37.
Deci, A. Santos, A. B. Hiott, W. et al (1995) Dissemination of assertive community treatment programs. Psychiatric Services, 46, 676678.
Dixon, L. B. Krauss, N. Kernan, E. et al (1995) Modifying the PACT model to service homeless persons with severe mental illness. Psychiatric Services, 46, 684688.
Drake, R. E. & Burns, B. J. (1995) Spectral section on assertive community treatment: an introduction. Psychiatric Services, 46, 667668.
Drummond, M. F. O'Brien, B. Stoddart, G. L. et al (1997) Methods for the Economic Evaluation of Health Care Programmes. Oxford: Oxford University Press.
Endicott, J. Spitzer, R. L. Fleiss, J. L. et al (1976) The Global Assessment Scale. A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry, 33, 766771.
Gray, A. M. Marshall, M. Lockwood, A. et al (1997) Problems in conducting economic evaluations alongside clinical trials: lessons from a study of case management for people with mental disorders. British Journal of Psychiatry, 179, 4752.
Houit, J. Reynolds, I. Charbonneau-Powis, M. et al (1983) Psychiatric hospital versus community treatment: a randomized trial. Australian and New Zealand Journal of Psychiatry, 17, 160167.
Kavanagh, S. & Stewart, A. (1995) Economic evaluations of mental health care: modes and method. In The Economic Evaluation of Mental Health Care (ed. M. R. J. Knapp), pp. 2760. Aldershot: Arena.
Knapp, M. R. J. (ed.) (1995a) The Economic Evaluation of Mental Health Care. Aldershot: Arena.
Knapp, M. R. J. (ed.) (1995b) Letter. British Journal of Psychiatry, 166, 120121.
Knapp, M. R. J. (ed.) (1995c) Community mental health services: towards an understanding of cost-effectiveness. In Collaborative Community Mental Health Care (eds F. Creed & P. Tyrer), pp. 111145. Sevenoaks: Edward Arnold.
Knapp, M. R. J. (ed.), Beecham, J. Koutiogeorgeopoulou, V. et al (1994) Service use and costs of home-based versus hospital-based care for people with serious mental illness. British Journal of Psychiatry, 165, 195203.
Larsen, D. H. Atkinson, C. C. Hargreaves, W. A. et al (1979) Assessment of client/patient satisfaction: development of a general scale. Evaluation and Program Planning, 2, 197207.
Lemmens, F. & Donker, M. (1990) Kwaliteitsbeoordeling door cienten, Utrecht: Netherlands Centrum Geestelijke Volksgezondheid.
Lukoff, D. Libarman, R. P. & Neuchterlein, K. H. (1986) Symptom monitoring in the rehabilitation of schizophrenic patients. Schizophrenia Bulletin, 12, 578602.
McCrone, P. & Thornicroft, G. (1997) Reading about health economics. British Journal of Psychiatry, 171, 191193.
Marks, I. M. (1995) Synopsis of the Daily Living Programme for the seriously mentally ill: a controlled comparison of home and hospital based care. In Community Psychiatry in Action: Analysis and Prospects (eds F. Creed & P. Tyrer). pp. 2944. Sevenoaks: Edward Arnold.
Marks, I. M. Connolly, J. Muijen, M. et al (1994) Home-based versus in-/out-patient care for serious mental illness: a controlled study. British Journal of Psychiatry, 157, 661670.
Mechanic, D. (1996) Emerging issues in international mental health services research. Psychiatric Services, 47, 371375.
Netten, A. (1993) Costing informal care. In Costing Community Care: Theory and Practice (eds A. Netten & J. Beecham), pp. 4357. Aldershot: Ashgate.
Overall, J. E. & Gorham, D. R. (1962) Impact of treatment intervention on the relationship between dimensions of clinical psychopathology, social dysfunction and burden on the family of psychiatric patients. British Journal of Psychiatry, 12, 651658.
Scott, J. E. & Dixon, L. B. (1996) Assertive community treatment and case management of schizophrenia. Schizophrenia Bulletin, 21, 657668.
Stein, L. I. & Test, M. (1980) Alternative to mental hospital treatment: Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry, 37, 392397.
Teague, G. B. Drake, R. E. & Ackerson, T. H. (1995) Evaluating use of continuous treatment teams for persons with mental illness and substance abuse. Psychiatric Services, 46, 689695.
Test, M. A. Knoedler, W. H. Allness, D. J. et al (1991) Long-term community care through an assertive continuous treatment team. Advances in Neuropsychiatry, 1, 239246.
Weistman, M. M. Paykel, E. S. Siegel, R. et al (1971) The social role performance of depressed women: comparisons with a normal group. American Journal of Orthopsychiatry, 41, 390405.
Wing, J. K. Cooper, J. E. & Sartorius, N. (1974) The Description and Classification of Psychiatric Symptoms: An Instruction Manual for the PSE and Catego System. Cambridge: Cambridge University Press.
Wolff, N. Helminiak, T. W. & Diamond, R. J. (1995) Estimated societal costs of assertive community mental health care. Psychiatric Services, 46, 898906.

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

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)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *