Cost-effectiveness of intensive v. standard case management for severe psychotic illness. UK700 case management trial. UK700 Group.

Abstract

Intensive case management is commonly advocated for the care of the severely mentally ill, but evidence of its cost-effectiveness is lacking. To investigate the cost-effectiveness of intensive compared with standard case management for patients with severe psychosis. 708 patients with psychosis and a history of repeated hospital admissions were randomly allocated to standard (case-loads 30-35) or intensive (case-loads 10-15) case management. Clinical and resource use data were assessed over two years. No statistically significant difference was found between intensive and standard case management in the total two-year costs of care per patient (means 24,550 Pounds and 22,700 Pounds, respectively, difference 1850 Pounds, 95% CI--1600 Pounds to 5300 Pounds). There was no evidence of differential effects in African-Caribbean patients or in the most disabled. Psychiatric in-patient hospital stay accounted for 47% of the total costs, but neither such hospitalisation nor other clinical outcomes differed between the randomised groups. Reduced case-loads have no clear beneficial effect on costs, clinical outcome or cost-effectiveness. The policy of advocating intensive case management for patients with severe psychosis is not supported by these results.