Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-27T16:17:12.895Z Has data issue: false hasContentIssue false
  • English
  • Français

Problems in conducting economic evaluations alongside clinical trials

Lessons from a study of case management for people with mental disorders

Published online by Cambridge University Press:  02 January 2018

Alastair Gray ,
Max Marshall ,
Austin Lockwood  and
Joan Morris
Alastair Gray*
Affiliation:
Wolfson College, University of Oxford
Max Marshall
Affiliation:
Department of Psychiatry, University of Manchester
Austin Lockwood
Affiliation:
Department of Psychiatry, University of Manchester
Joan Morris
Affiliation:
Wolfson Institute of Preventive Medicine, Medical College of St Bartholomew's Hospital, University of London
*
Dr Alastair Gray, Health Economics Group, Centre for Socio-Legal Studies, Wolfson College, University of Oxford, Oxford OX2 6UD. Fax: 01865 284221; e-mail: alastair.gray@[email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Case management has become the statutory basis of community care in the UK for people with long-term mental disorders, although a randomised controlled trial found no important improvements over standard care. Here we compare the costs and cost consequences of this intervention with standard care.

Method

Resource-use data were collected over a six-month baseline period and for 14 months after randomisation on all patients in the trial.

Results

At 14 months the ratio of control group to treatment group weekly costs was 1.09 (95% CI 0.86–1.38) for total costs; 1.12 (0.76–1.65) for state benefits, and 1.21 (0.61–2.42) for health care costs. Costs were thus lower in the treatment group, but these differences were not significant.

Conclusions

Retrospective power calculations indicated that the trial could have detected differences of 30% in total cost, but would have required 700 patients per arm to detect a 20% difference in health care costs. Hence this study, which had adequate power to detect clinically meaningful differences, was found to be far too small to detect large differences in costs. Funding agencies increasingly request that clinical trials include economic alongside clinical end-points: these findings may have important lessons for that policy.

Type
Papers
Information
The British Journal of Psychiatry , Volume 170 , Issue 1 , January 1997 , pp. 47 - 52
Copyright
Copyright © 1997 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adams, M. (1992) Economic analysis in randomized controlled trials. Medical Care. 30, 231–244.Google Scholar
Advisory Committee on Health Technology Assessment (1992) Assessing the Effects of Health Technologies: Principles. Practice and Proposals. London: Her Majesty's Stationery Office, for the Department of Health.Google Scholar
Armitage, P. & Berry, G. (1994) Statistical methods in medical research(3rd edn). Oxford: Blackwell Scientific.Google Scholar
Burns, T., Raftery, J. Besdsmoore, A., et al (1991) A controlled trial of home-based acute psychiatric services. II: Treatment patterns and costs. British Journal of Psychiatry. 163, 55–61.Google Scholar
Drummond, M. (1980) Principles of Economic Appraisal in Health Care. Oxford: Oxford University Press.Google Scholar
Drummond, M., & O'Brian, B. (1993) Clinical importance, statistical significance and the assessment of economic and quality-of-life outcomes. Health Economics. 2, 205–212.Google Scholar
Drummond, M., O'Brian, B., Stoddart, G. & Torrance, G. (1987) Methods for Economic Evaluation of Health Care Programs. Oxford: Oxford University Press.Google Scholar
Franklin, J., Solovitz, B., Mason, M., et al (1987) An evaluation of case management. American Journal of Public Health. 77, 674–678.Google Scholar
Gardener, M. J. & Altman, D. G. (1989) Statistics with Confidence – Confidence Intervals and Statistical Guidelines. London: British Medical Journal.Google Scholar
Griffiths, R. (1988) Community Care: Agenda for Action. London: Her Majesty's Stationery Office.Google Scholar
Heyting, A., Tolboom, J. T. M. & Essers, J. G. A. (1992) Statistical handling of drop-outs in longitudinal clinical trials. Statistics in Medicine, 11, 2043–2061.Google Scholar
Holloway, F., McLean, E. K. & Robartson, J. A. (1991) Case management. British Journal of Psychiatry 159, 142–148.Google Scholar
Knapp, M. (1993) Principles of applied cost research. In Costing Community Care: Theory and Practice(eds Netten, A. & Beecham, J.), Aldershot: Ashgate.Google Scholar
Knapp, M., Beecham, J., Koutsogwogopoulou, V., et al (1994) Service use and costs of home-based versus hospital-based care for people with serious mental illness. British Journal of Psychiatry, 165, 195–203.Google Scholar
Mangen, S. P., Paykol, E. S., Griffith, J. H., et al (1983) Cost-effectiveness of community psychiatric nurse or out-patient psychiatrist care of neurotic patients. Psychdogical Medicine. 13, 407–416.Google Scholar
Marshall, M., Lockwood, A., & Gath, D. (1995a) effective is social services case management for people with long-term mental disorders? A randomised controlled trial. Lancet, 345, 409–412.Google Scholar
Marshall, M., Lockwood, A., Gath, D., Hogg, L., Lockwood, A., et al (1995b) The Cardinal Needs Schedule: a modified version of the MRC Needs for Care Schedule. Psychological Medicine, 25, 605–617.Google Scholar
Muijen, M., Cooney, M., Strathdee, G., et al (1994) Community psychiatric nurse teams: intensive support versus generic care. British Journal of Psychiatry 165, 211–217.Google Scholar
O'Brien, B., Drummond, M., Labeile, R. J., et al (1994) In search of power and significance: issues in the design and analysis of stochastic cost-effectiveness studies in health care. Medical Care. 32, 150–163.Google Scholar
Tarrier, N., Lowson, K. & Bow, C. (1991) Some aspects of family interventions in schizophrenia. II: Financial considerations. British Journal of Psychiatry 159, 481–484.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.