[PMH11] Deinstitutionalization model in schizophrenia: cost-consequences of intensive case management versus standard case management

[PMH11] Deinstitutionalization model in schizophrenia: cost-consequences of intensive case management versus standard case management

2000 Value in health

Llorca, P.M. | Toumi, M. | Francois, C. | Hansen, K. | Lancon, C. | Volume: 3, Issue: 5, Pages: 347, model, Schizophrenia, methods,

OBJECTIVE: A model was developed to assess the clinical
outcome and costs of an intensive deinstitutionalization
strategy called Intensive Case Management (ICM) in comparison
to Standard Case Management (SCM) for persons
suffering of chronic schizophrenia and long term hospitalized
(1 year). METHODS: A Markov Model was constructed
to describe the different possibilities of case management
of long term hospitalized schizophrenic patients.
The Markov states were classified to one of five categories
hospital, institution, outpatient, dropout, and death, followed
by either success or failure of the adopted case management.
Clinical, functioning improvement, and patient
discharge from acute care unit define success here. The
Markov process iterates in 1-year cycles until the 5-year.
Model probabilities are gathered from an ongoing ambispective
cohort of patients assigned to ICM or SCM in the
catchment area of Clermont-Ferrand. Control patients
(SCM) were/are retrospectively chosen on the premise that
they could have been selected for ICM group. Service utilization
data are obtained from patient medical and administrative
record while direct costs are obtained from the analytical
accounting system of the catchment area. RESULTS:
Based on the primary data collected (ICM: n 42, SCM:
n 28), the outcomes of the two types of care showed,
that the ICM was more effective in terms of success over
the first one-year period 59% of the patients experienced a
success as opposed to 25% in SCM. It was also shown that
readmission to hospital was more likely in the SCM (67%
as opposed to 22% in ICM). A threshold analysis will be
performed in order to evaluate at which point ICM will
be too costly for the hospital budget. CONCLUSIONS:
With these outcome results, ICM is shown to be more effective
than SCM. The model will be used to generate costeffectiveness
ratios, budgetary previsions for large-scale implementation
of ICM, in order to help decision-makers in
policy-making for mental health care organizations.

https://www.doi.org/10.1016/S1098-3015(11)70749-5