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Economic evaluation of intensive home treatment in comparison to care as usual alongside a randomised controlled trial

Author

Listed:
  • Ansam Barakat

    (Amsterdam Public Health Research Institute Amsterdam UMC
    Arkin Institute for Mental Health Care)

  • Jurgen E. Cornelis

    (Arkin Institute for Mental Health Care
    Arkin Institute for Mental Health Care)

  • Jack J. M. Dekker

    (Arkin Institute for Mental Health Care
    Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam)

  • Nick M. Lommerse

    (Arkin Institute for Mental Health Care)

  • Aartjan T. F. Beekman

    (Amsterdam Public Health Research Institute Amsterdam UMC
    GGZ InGeest Specialized Mental Health Care)

  • Matthijs Blankers

    (Arkin Institute for Mental Health Care
    Trimbos Institute, Netherlands Institute of Mental Health and Addiction
    Amsterdam Public Health research institute Amsterdam UMC)

Abstract

Background There is a dearth of research on the cost-effectiveness of intensive home treatment (IHT), an alternative to psychiatric hospitalisation for patients experiencing psychiatric crises. We therefore present a health economic evaluation alongside a pre-randomised controlled trial of IHT compared to care as usual (CAU). Method Patients were pre-randomised to IHT or CAU using a double-consent open-label Zelen design. For the cost-utility analysis, the EuroQol 5-dimensional instrument was used. The cost-effectiveness was assessed using the Brief Psychiatric Rating Scale (BPRS). Results Data of 198 patients showed that each additional QALY gained from offering IHT instead of CAU was on average associated with an extra cost of €48,003. There is a 38% likelihood that IHT will lead to more QALYs at lower costs compared to CAU. An improvement of one additional point on the BPRS by offering IHT instead of CAU was associated with an extra cost of €19,203. There is a 38% likelihood that IHT will lead to higher BPRS score improvements at lower costs. Based on the NICE willingness-to-pay threshold of £30,000 (€35,000) per QALY, IHT could potentially be considered cost-effective with a likelihood of 55–60% when viewed from a societal perspective, and > 75% from a health care perspective. Conclusions IHT appears slightly more attractive in terms of cost-utility and cost-effectiveness than CAU, although differences in both costs and effects are small especially when viewed from the societal costs perspective. From the health care sector costs perspective, IHT has a higher probability of being cost-effective compared to CAU. Trials registration Netherlands Trial Register: NTR6151.

Suggested Citation

  • Ansam Barakat & Jurgen E. Cornelis & Jack J. M. Dekker & Nick M. Lommerse & Aartjan T. F. Beekman & Matthijs Blankers, 2025. "Economic evaluation of intensive home treatment in comparison to care as usual alongside a randomised controlled trial," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 26(1), pages 23-34, February.
  • Handle: RePEc:spr:eujhec:v:26:y:2025:i:1:d:10.1007_s10198-024-01675-1
    DOI: 10.1007/s10198-024-01675-1
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    References listed on IDEAS

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    1. Rita Faria & Manuel Gomes & David Epstein & Ian White, 2014. "A Guide to Handling Missing Data in Cost-Effectiveness Analysis Conducted Within Randomised Controlled Trials," PharmacoEconomics, Springer, vol. 32(12), pages 1157-1170, December.
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    More about this item

    Keywords

    Economic evaluation; Intensive home treatment; Emergency psychiatry; Pre-randomised controlled trial;
    All these keywords.

    JEL classification:

    • H12 - Public Economics - - Structure and Scope of Government - - - Crisis Management
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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