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Cost-effectiveness of intensive home treatment enhanced by inpatient treatment elements in child and adolescent psychiatry in Germany: A randomised trial

Published online by Cambridge University Press:  15 April 2020

I. Boege ,
N. Corpus ,
R. Schepker ,
R. Kilian  and
J.M. Fegert
I. Boege*
Affiliation:
ZfP Suedwuerttemberg, Child and Adolescent Psychiatry, Weingartshoferstrasse 2, 88214Ravensburg, Germany University of Ulm, Department of Child and Adolescent Psychiatry, Ulm, Germany
N. Corpus
Affiliation:
ZfP Suedwuerttemberg, Child and Adolescent Psychiatry, Weingartshoferstrasse 2, 88214Ravensburg, Germany
R. Schepker
Affiliation:
University of Ulm, Department of Child and Adolescent Psychiatry, Ulm, Germany
R. Kilian
Affiliation:
University of Ulm, Psychiatry II, BKH Günzburg, Günzburg, Germany
J.M. Fegert
Affiliation:
University of Ulm, Department of Child and Adolescent Psychiatry, Ulm, Germany
*
⁎Corresponding author. Tel.: +49 751 7601 2405; fax: +49 751 7601 2121. E-mail address:[email protected] (I. Boege).
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Abstract

Background

Admission rate to child and adolescent mental health inpatient units in Germany is high (54 467 admissions in 2013), resources for providing necessary beds are scarce. Alternative pathways to care are needed. Objective of this study was to assess the cost-effectiveness of inpatient treatment versus Hot-BITs-treatment (Hometreatment brings inpatient-treatment outside), a new supported discharge service offering an early discharge followed by 12 weeks of intensive support.

Methods

Of 164 consecutively recruited children and adolescents, living within families and being in need of inpatient mental health care, 100 patients consented to participate and were randomised via a computer-list into intervention (n = 54) and control groups (n = 46). Follow-up data were available for 76 patients. Primary outcome was cost-effectiveness. Effectiveness was gathered by therapist-ratings on the Children's Global Assessment Scale (CGAS) at baseline (T1), treatment completion (T2) and an 8-month-follow-up (T3). Cost of service use (health care costs and non–health care costs) was calculated on an intention-to-treat basis at T2 and T3.

Results

Significant treatment effects were observed for both groups between T1/T2 and T1/T3 (P < 0.001). The Hot-BITs treatment, however, was associated with significantly lower costs at T2 (difference: −6900.47€, P = 0.013) and T3 (difference: −8584.10€, P = 0.007). Bootstrap cost-effectiveness ratio indicated that Hot-BITs was less costly and tended to be more effective at T2 and T3.

Conclusions

Hot-BITs may be a feasible cost-effective alternative to long inpatient stays in child and adolescent psychiatry. Further rigorous evaluations of the model are required. (Registration number: ISRCTN02672532, part 1, Current Controlled Trials Ltd, URL: http://www.controlled-trials.com).

Keywords

Economic evaluationCommunity programsLiaison child psychiatryQuality of lifeService development
Type
Original article
Information
European Psychiatry , Volume 30 , Issue 5 , July 2015 , pp. 583 - 589
Copyright
Copyright © Elsevier Masson SAS 2015

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References

Barkmann, C., Schulte-Markwort, M.. Prevalence of emotional and behavioural disorders in German children and adolescents: a meta-analysis. J Epidemiol Community Health 2010;66(3):194–203.CrossRefGoogle ScholarPubMed
Beecham, J.. Annual research review: child and adolescent mental health interventions: a review in progress in economic studies across different disorders. J Child Psychol Psychiatry 2014;55(6):714–732.CrossRefGoogle ScholarPubMed
Boege, I., Copus, N., Schepker, R.. Behandelt zu Hause Gesund werden. Z Kinder Jugendpsychiatr Psychother 2014;42(1):27–37.CrossRefGoogle Scholar
Butler, S.M., Baruch, G., Hickey, N., Fonagy, P.. A randomized controlled trial of multisystemic therapy and a statutory therapeutic intervention for young offenders. J Am Acad Child Adolesc Psychiatry 2011;50(12):1220–1235.CrossRefGoogle Scholar
Cary, M., Butler, S., Barauch, G., Hickey, N., Byford, S.. Economic evaluation of multisystemic therapy for young people at risk for continuing criminal activity in the UK. PLoS One 2011;8(4):e61070.http://dx.doi.org/10.1371/journal.pone.0061070.CrossRefGoogle Scholar
Forster, E.M., Connor, T.. Public cost of better mental health services for children and adolescents. Psychiatr Serv 2005;56:50–55.CrossRefGoogle Scholar
Grimes, K.E., Schulz, M.F., Cohen, S.A., Mullin, B.O., Lehar, S.E., Tien, S.. Pursuing cost effectiveness in mental health service delivery for youth with complex needs. J Ment Health Policy Econ 2011;14(2):73–83.Google ScholarPubMed
Henggeler, S.W., Rowland, M.D., Randall, J., Ward, D.M., Pickrel, S.G., Cunningham, P.B., et al.Home-based multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis: clinical outcomes. J Am Acad Child Adolesc Psychiatry 1999;38:1331–1339.CrossRefGoogle ScholarPubMed
Hölling, H., Schlack, R., Petermann, F., Ravens-Sieberer, U., Mauz, E.. Psychopathological problems and psychosocial impairment in children and adolescents aged 3-17 years in the German population: prevalence and time trends at two measurement points (2003–2006 and 2009–2012). Results of the KiGGS study: first follow-up (KiGGS Wave 1). Bundesgesundheitsbl 2014;57:807–819.CrossRefGoogle Scholar
Knapp, M., King, D., Healey, A., Thomas, C.. Economic outcomes in adulthood and their associations with antisocial conduct, attention deficit and anxiety problems in childhood. J Ment Health Policy Econ 2011;14:122–132.Google ScholarPubMed
Knapp, M., Snell, T., Healey, A., Guglani, S., Evans-Lacko, S., Fernandez, J.L., et al.How do child and adolescent mental health problems influence public sector costs? Interindividual variations in a nationally representative British sample. J Child Psychol Psychiatry 2014.http://dx.doi.org/10.1111/jcpp12327 [epub ahead of print].Google Scholar
Lamb, C.E.. Alternatives to admission for children and adolescents: providing intensive mental healthcare services at home and in communities: what works?. Curr Opin Psychiatry 2009;22:345–350.CrossRefGoogle Scholar
Lee, B.R., Ebesutani, C., Kolivoski, K.M., Becker, K.D., Lindsey, M.A., Brandt, N.E., et al.Program and practice elements for placement prevention: a review of interventions and their effectiveness in promotiong home-based care. Am J Orthopsychiatry 2014;84(3):244–256.CrossRefGoogle Scholar
Marshall, M., Lockwood, A.Assertive community treatment for people with severe mental disorders. Cochrane Database Syst Rev 2000;CD001089.Google ScholarPubMed
Mattejat, F., Hirt, B.R., Wilken, J., Schmidt, M.H., Remschmidt, H.. Efficacy of inpatient and home treatment in psychiatrically disturbed children and adolescents. Follow-up assessment of the results of a controlled treatment study. Eur Child Adolesc Psychiatry 2001;10(Suppl. 1):I71–I179.CrossRefGoogle ScholarPubMed
Mattejat, F., Simon, B., König, U., Quaschner, K., Barchewitz, C., Felbel, D., et al.Quality of life of children and adolescents with psychiatric disorders. Results of the first multicenter study with an inventory to assess the quality of life in children and adolescents. Z Kinder- Jugendpsychiatr Psychother 2003;31(4):293–303.CrossRefGoogle ScholarPubMed
Merikangas, K.R., Nakamura, E.F., Kessler, R.C.. Epidemiology of mental disorders in children and adolescents. Dialogues Clin Neurosci 2010;11(1):7–20.Google Scholar
O’Herlity, A., Worrall, A., Banerjee, S., Jaffa, T., Hill, P., Mears, A., et al.National inpatient Child and Adolescent Psychiatry Study (NICAPS). London: College Research Unit of the Royal College of Psychiatrists and Department of Health; 2010, http://www.rcpsych.ac.uk/PDF/NICAPS%20report%20full.pdf.Google Scholar
Olesen, J., Gustavsson, A., Svensson, M., Wittchen, H.U., Jensson, B.on behalf of the CDBE2010 study group and the European Brain Council. The economic cost of brain disorders in Europe. Eur J Neurol 2012;19:155–162.CrossRefGoogle Scholar
Ougrin, D., Zundel, T., Corrigal, R., Padmore, J., Loh, C.Pilot evaluation of the supported discharge service (SDS): clinical outcomes and use. Child Adolesc Mental Health 2013. http://dx.doi.org/10.1111/camh.12038.Google Scholar
Petrou, S., Johnson, S., Wolke, D., Hollis, C., Kochhar, P., Marlow, N.. Economic costs and preference-based health-related quality of life outcomes associated with childhood psychiatric disorders. Br J Psychiatry 2010;197:395–404.CrossRefGoogle ScholarPubMed
Pottick, K., Hansell, S., Gutterman, E., Raskin-White, H.. Factors associated with inpatient and outpatient treatment for children and adolescents with serious mental illness. J Am Acad Child Adolesc Psychiatry 1995;34(4):425–433.CrossRefGoogle ScholarPubMed
Rehberg, W., Fuerstenau, U., Rhiner, B.. Multisystemic therapy (MST) for youths with severe conduct disorders – economic evaluation of the implementation in a German-speaking environment. Z Kinder Jugendpsychiatr Psychother 2011;39(1):41–45.CrossRefGoogle Scholar
Rhiner, B., Graf, T., Dammann, G., Fuerstenau, U.. Multisystemic therapy for adolescents in Switzerland – implementation and first results. Z Kinder Jugendpsychiatr Psychother 2011;39:33–39.CrossRefGoogle ScholarPubMed
Salize, H.J., Kilian, R.Gesundheitsökonomie in der Psychiatrie: Konzepte, Methoden, Analysen. Stuttgart: Kohlhammer GmBH Stuttgart; 2010 [1. Auflage; ISBN 978-3-17 019839-5].Google Scholar
Schmidt, M.H., Lay, B., Göpel, C., Naab, S., Blanz, B.Hometreatment for children and adolescents with psychiatric disorders. Eur Child Adolesc Psychiatry 2006;15:265–276.CrossRefGoogle Scholar
Shaffer, D., Gould, M.S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., et al.A children's global assessment scale. Arch Gen Psychiatry 1983;40:1228–1231.CrossRefGoogle ScholarPubMed
Snell, T., Knapp, M., Healey, A., Guglani, S., Evans-Lacko, S.Economic impact of childhood psychiatric disorder on public sector services in Britain: estimates from national survey data. J Child Psychol Psychiatry 2013;54(9):977–985.CrossRefGoogle ScholarPubMed
Suter, J.C., Bruns, E.J.Effectiveness of the wraparound process for children with emotional and behavioral disorders: a meta-analysis. Clin Child Fam Psychol Rev 2009;12:336–351.CrossRefGoogle ScholarPubMed
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