Similar cost-better results: the case of the hybrid Assertive Community Treatment model of care for severely mentally ill patients in rural Greece.

Abstract

The present study evaluated the impact of a hybrid Assertive Community Treatment (ACT) model of care on the direct medical costs of treating severe mental illness (SMI) patients in rural Greece. The study aimed to determine whether this model resulted in significant cost differences compared to usual treatment while also assessing its cost-effectiveness based on clinical improvements. A total of 23 patients with SMI and multiple hospitalizations were followed up for 16 months under the hybrid ACT model. Direct medical costs were estimated using previously published Greek data on schizophrenia treatment costs. Cost differences before and after the implementation of the hybrid ACT model were calculated, and cost-effectiveness was assessed using the Incremental Cost-Effectiveness Ratio (ICER), which reflects the cost per unit increase in Global Assessment of Functioning (GAF) scores. There was no statistically significant difference in direct medical costs between usual care (310,029€) and hybrid ACT care (313,896€), with a small cost increase of 3,867€ (p = 0.077). However, hybrid ACT care significantly reduced hospitalizations and length of inpatient stay, leading to an 86.9% reduction in total inpatient days. Clinical improvements were also observed, with GAF scores increasing from 40.43 to 47.26. Cost-effectiveness analysis demonstrated a particularly low ICER of 25.9€ per GAF point gained, suggesting a cost-efficient intervention. In an alternative scenario, the 2024 pricing was estimated with the use of the Consumer Price Index. In this case, the hybrid ACT care appeared to be significantly cost-saving by 25.5%. A rough estimation of indirect costs revealed further cost savings in favor of the hybrid ACT. The hybrid ACT model proved to be cost-effective due to its strong impact on reducing inpatient care and improving patient functioning. These findings align with international studies demonstrating the economic and clinical benefits of community-based mental health care. Future research should focus on larger, multicenter studies to confirm cost-effectiveness and explore the impact on indirect costs, such as caregiver burden and law enforcement involvement. The results support further investment in hybrid ACT services in rural Greece to enhance mental health care delivery in low-resourced settings.