Cost variation in child and adolescent psychiatric inpatient treatment

Area of Science:

• Child and Adolescent Psychiatry
• Health Economics
• Healthcare Management

Background:

• Current cost data for child and adolescent psychiatric inpatient services lack patient needs and outcomes linkage.
• Budgetary concerns alone may lead to reduced inpatient service provision without considering clinical impact.
• Understanding the full cost spectrum is crucial for effective healthcare commissioning.

Purpose of the Study:

• To estimate the support costs associated with child and adolescent psychiatric inpatient admissions (pre-, during, and post-admission).
• To explore the relationships between these costs, patient needs, and treatment outcomes.
• To inform national tariff development for inpatient psychiatric episodes.

Main Methods:

• Prospective cohort study involving eight child and adolescent psychiatric units.
• Participants assessed at referral, admission, decision to discharge, and 1-year follow-up.
• Detailed cost analysis including pre-, during, and post-admission support costs.

Main Results:

• Mean inpatient admission cost was £24,120, with significant variation observed.
• Costs were associated with patient global impairment, age, and exclusion status.
• Post-admission support costs were comparable to pre-admission costs, with improved service targeting.

Conclusions:

• National tariff development for inpatient psychiatric episodes should focus on the total cost of treatment episodes, not daily costs.
• Effective commissioning necessitates a deeper understanding of cost predictors and their link to patient needs and outcomes.
• Further research is needed to refine cost-outcome associations in child and adolescent mental health services.