Cost Utility of Intensive Home Treatment Compared With Acute Psychiatric Inpatient Admission

Area of Science:

• Health Economics
• Psychiatric Care
• Mental Health Services Research

Background:

• Intensive home treatment (IHT) is recognized as a safe and effective alternative to psychiatric inpatient care during acute crises.
• Severe mental illness (SMI) management requires efficient and effective treatment strategies, particularly during acute episodes.

Purpose of the Study:

• To evaluate the cost-effectiveness of Intensive Home Treatment (IHT) versus traditional inpatient treatment for individuals with severe mental illness experiencing acute crises within the German healthcare system.

Main Methods:

• A quasi-experimental, non-randomized trial involving 400 patients (200 IHT, 200 inpatient) across 10 German sites from January 2021 to December 2022.
• Propensity score matching was used to create comparable groups, with a 12-month observation period.
• Cost-utility analysis was conducted from societal and statutory health insurance perspectives, calculating Incremental Cost Utility Ratios (ICURs) and using bootstrapping for uncertainty analysis.

Main Results:

• The study found point estimates for ICURs of €48,786.43 (statutory health insurance perspective) and €38,433.81 (societal perspective).
• Acceptability rates for IHT as a cost-effective option were 67% (societal) and 60% (statutory health insurance) at a willingness-to-pay threshold of €25,000.
• Acceptability decreased at a €50,000 threshold, with rates of 50% (societal) and 44% (statutory health insurance).

Conclusions:

• Intensive Home Treatment (IHT) demonstrates potential cost-effectiveness compared to inpatient care for acute psychiatric crises in individuals with severe mental illness.
• While results suggest IHT is a viable economic alternative, significant stochastic uncertainty necessitates further research for clearer economic efficiency assessment.
• The findings indicate a slightly higher probability of cost-effectiveness for statutory health insurance compared to the overall economy.