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Barakat A, Cornelis JE, Dekker JJM, Lommerse NM, Beekman ATF, Blankers M. Economic evaluation of intensive home treatment in comparison to care as usual alongside a randomised controlled trial. Eur J Health Econ 2024:10.1007/s10198-024-01675-1. [PMID: 38598073 DOI: 10.1007/s10198-024-01675-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/18/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND There is a dearth of research on the cost-effectiveness of intensive home treatment (IHT), an alternative to psychiatric hospitalisation for patients experiencing psychiatric crises. We therefore present a health economic evaluation alongside a pre-randomised controlled trial of IHT compared to care as usual (CAU). METHOD Patients were pre-randomised to IHT or CAU using a double-consent open-label Zelen design. For the cost-utility analysis, the EuroQol 5-dimensional instrument was used. The cost-effectiveness was assessed using the Brief Psychiatric Rating Scale (BPRS). RESULTS Data of 198 patients showed that each additional QALY gained from offering IHT instead of CAU was on average associated with an extra cost of €48,003. There is a 38% likelihood that IHT will lead to more QALYs at lower costs compared to CAU. An improvement of one additional point on the BPRS by offering IHT instead of CAU was associated with an extra cost of €19,203. There is a 38% likelihood that IHT will lead to higher BPRS score improvements at lower costs. Based on the NICE willingness-to-pay threshold of £30,000 (€35,000) per QALY, IHT could potentially be considered cost-effective with a likelihood of 55-60% when viewed from a societal perspective, and > 75% from a health care perspective. CONCLUSIONS IHT appears slightly more attractive in terms of cost-utility and cost-effectiveness than CAU, although differences in both costs and effects are small especially when viewed from the societal costs perspective. From the health care sector costs perspective, IHT has a higher probability of being cost-effective compared to CAU. TRIALS REGISTRATION Netherlands Trial Register: NTR6151.
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Affiliation(s)
- Ansam Barakat
- Department of Psychiatry Amsterdam UMC/VUmc, Amsterdam Public Health Research Institute Amsterdam UMC, Amsterdam, The Netherlands.
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands.
| | - Jurgen E Cornelis
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
- Department of Emergency Psychiatry, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
| | - Jack J M Dekker
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Nick M Lommerse
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry Amsterdam UMC/VUmc, Amsterdam Public Health Research Institute Amsterdam UMC, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Matthijs Blankers
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
- Department of Psychiatry Amsterdam UMC/AMC , Amsterdam Public Health research institute Amsterdam UMC, Amsterdam, The Netherlands
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Barakat A, Blankers M, Cornelis JE, Lommerse NM, Beekman AT, Dekker JJ. Prescriptive factors for intensive home treatment in acute psychiatry: a secondary analysis of a randomised controlled trial. Int J Ment Health Syst 2024; 18:2. [PMID: 38172935 PMCID: PMC10763431 DOI: 10.1186/s13033-023-00619-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Intensive home treatment (IHT) aims to prevent psychiatric hospitalisation. Although this intervention is well tested, it is still unknown for whom this intervention works best. Therefore, this study aims to explore prescriptive factors that moderate the effect of IHT compared to care as usual (CAU) on symptom severity. METHODS Using data from a randomised controlled trial, 198 participants that experience an exacerbation of acute psychiatric symptoms were included in this secondary analysis. In order to maximise clinical relevance, generally available environmental and clinical baseline factors were included as tentative moderators: age, gender, employment status, domestic situation, psychiatric disorders, psychological symptoms, psychosocial functioning, alcohol and other substance use. The outcome variable symptom severity was measured using the Brief Psychiatric Rating Scale (BPRS) and collected at 26 and 52 weeks post-randomisation. Multiple regression analysis was used to examine which participants' characteristics moderate the effect of IHT on the total BPRS score. RESULTS Our results suggest that being employed (B = 0.28, SE = 0.13, 95% CI = 0.03-0.53, p = 0.03) at baseline seems to have a moderation effect, which result in lower symptom severity scores at 26 weeks follow-up for patients who received IHT. This effect was not found at 52 weeks. CONCLUSIONS On the basis of the number of factors tested, there is no evidence for robust outcome moderators of the effect of IHT versus CAU. Our conclusion is therefore that IHT can be offered to a diverse target population with comparable clinical results. TRIAL REGISTRATION This trial is registered (date of registration: 2016-11-23) at the international clinical trials registry platform (NTR6151).
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Affiliation(s)
- Ansam Barakat
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands.
- Department of Psychiatry Amsterdam UMC/VUmc, Amsterdam Public Health research institute Amsterdam UMC, Amsterdam, The Netherlands.
| | - Matthijs Blankers
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
- Trimbos-Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
- Department of Psychiatry Amsterdam UMC/AMC, Amsterdam Public Health research institute Amsterdam UMC, Amsterdam, The Netherlands
| | - Jurgen E Cornelis
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
- Department of Emergency Psychiatry, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
| | - Nick M Lommerse
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
| | - Aartjan Tf Beekman
- Department of Psychiatry Amsterdam UMC/VUmc, Amsterdam Public Health research institute Amsterdam UMC, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Jack Jm Dekker
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute Amsterdam UMC, Amsterdam, The Netherlands
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Barakat A, Blankers M, Cornelis JE, van der Post L, Lommerse NM, Beekman ATF, Dekker JJM. Police Encounters, Agitation, Diagnosis, and Employment Predict Psychiatric Hospitalisation of Intensive Home Treatment Patients During a Psychiatric Crisis. Front Psychiatry 2021; 12:602912. [PMID: 33633607 PMCID: PMC7901988 DOI: 10.3389/fpsyt.2021.602912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/13/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: This study aims to determine factors associated with psychiatric hospitalisation of patients treated for an acute psychiatric crisis who had access to intensive home treatment (IHT). Methods: This study was performed using data from a randomised controlled trial. Interviews, digital health records and eight internationally validated questionnaires were used to collect data from patients on the verge of an acute psychiatric crisis enrolled from two mental health organisations. Thirty-eight factors were assigned to seven risk domains. The seven domains are "sociodemographic", "social engagement", "diagnosis and psychopathology", "aggression", "substance use", "mental health services" and "quality of life". Multiple logistic regression analysis (MLRA) was conducted to assess how much pseudo variance in hospitalisation these seven domains explained. Forward MLRA was used to identify individual risk factors associated with hospitalisation. Risks were expressed in terms of relative risk (RR) and absolute risk difference (ARD). Results: Data from 183 participants were used. The mean age of the participants was 40.03 (SD 12.71), 57.4% was female, 78.9% was born in the Netherlands and 51.4% was employed. The range of explained variance for the domains related to "psychopathology and care" was between 0.34 and 0.08. The "aggression" domain explained the highest proportion (R 2 = 0.34) of the variance in hospitalisation. "Quality of life" had the lowest explained proportion of variance (R 2 = 0.05). The forward MLRA identified four predictive factors for hospitalisation: previous contact with the police or judiciary (OR = 7.55, 95% CI = 1.10-51.63; ARD = 0.24; RR = 1.47), agitation (OR = 2.80, 95% CI = 1.02-7.72; ARD = 0.22; RR = 1.36), schizophrenia spectrum and other psychotic disorders (OR = 22.22, 95% CI = 1.74-284.54; ARD = 0.31; RR = 1.50) and employment status (OR = 0.10, 95% CI = 0.01-0.63; ARD = -0.28; RR = 0.66). Conclusion: IHT teams should be aware of patients who have histories of encounters with the police/judiciary or were agitated at outset of treatment. As those patients benefit less from IHT due to the higher risk of hospitalisation. Moreover, type of diagnoses and employment status play an important role in predicting hospitalisation.
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Affiliation(s)
- Ansam Barakat
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam University Medical Centres (UMC), Location VUmc, Amsterdam Public Health Research Institute Amsterdam UMC, Amsterdam, Netherlands
| | - Matthijs Blankers
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, Netherlands.,Trimbos-Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands.,Department of Psychiatry, Amsterdam University Medical Centres (UMC), Location AMC, Amsterdam Public Health Research Institute Amsterdam UMC, Amsterdam, Netherlands
| | - Jurgen E Cornelis
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, Netherlands.,Department of Emergency Psychiatry, Arkin Institute for Mental Health Care, Amsterdam, Netherlands
| | - Louk van der Post
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, Netherlands
| | - Nick M Lommerse
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam University Medical Centres (UMC), Location VUmc, Amsterdam Public Health Research Institute Amsterdam UMC, Amsterdam, Netherlands.,Department of Research and Innovation, GGZ InGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | - Jack J M Dekker
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, Netherlands.,Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute Amsterdam UMC, Amsterdam, Netherlands
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