Cost-effectiveness of community versus hospital-based mental healthcare for severe mental illness in South-East Europe: economic evaluation of five randomised trials.
Ben Wijnen, Filip Smit, Ana Ivičević Uhernik, Ana Žegrec, Jovo Dedovic, Roumyana Dinolova, Raluca Nica, Aleksander Tomcuk, Robert Velickovski, Michel Wensing, Laura Shields-Zeeman, Ionela Petrea
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引用次数: 0
Abstract
Introduction: The RECOVER-E project supported the shift away from mental health care provided in institutional settings (treatment as usual, TAU) towards community-based mental healthcare by introducing multidisciplinary community mental health teams (CMHT) for people with schizophrenia, bipolar disorder, and severe depression across five sites in Bulgaria, Croatia, Montenegro, North Macedonia, and Romania. This paper presents the cost-effectiveness of CMHT compared to TAU.
Methods: Data from all five RECOVER-E trials (N = 931) was used to compute healthcare costs and societal costs which included additional patient and family costs, and costs stemming from productivity losses. Outcomes were incremental cost-effectiveness ratio's (ICER) for gaining a QALY and gaining a treatment responder (based on WHODAS 2.0).
Results: Compared to TAU, CMHT had small incremental effects favouring CMHT (QALY: M = 0·023, SD = 0·013; Response: M = 0·093, SD = 0·034). The incremental costs were higher in CMHT than in TAU as seen from both the societal and healthcare perspective (societal costs: M=€1,892, SD=€950; healthcare costs: M = 1,125, SD=€720). The ICER for gaining a QALY was €82,261 and €48,913 as seen from the societal and healthcare perspective, respectively. These ICERs were well above the willingness to pay threshold of €20,000 for gaining a QALY. A similar picture arose with treatment response as outcome.
Conclusion: Overall CMHT appeared to be more effective but also more costly, with the additional cost outweighing the benefits across countries, except in Bulgaria, which may highlight that cost-effectiveness is likely to be context dependent. Therefore, a recommendation for scaling up or sustaining CMHT must also depend on arguments other than health-economic alone, such as medical ethical, equity and human rights considerations.
期刊介绍：
The European Journal of Health Economics is a journal of Health Economics and associated disciplines. The growing demand for health economics and the introduction of new guidelines in various European countries were the motivation to generate a highly scientific and at the same time practice oriented journal considering the requirements of various health care systems in Europe. The international scientific board of opinion leaders guarantees high-quality, peer-reviewed publications as well as articles for pragmatic approaches in the field of health economics. We intend to cover all aspects of health economics:
• Basics of health economic approaches and methods
• Pharmacoeconomics
• Health Care Systems
• Pricing and Reimbursement Systems
• Quality-of-Life-Studies The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfill the above-mentioned requirements.
Officially cited as: Eur J Health Econ
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