© 2000 The Royal College of Psychiatrists
Cost-effectiveness of intensive v. standard case management for severe psychotic illness
UK700 case management trial
Centre for Health Economics, York
St George's Hospital, London
Centre for Health Economics, York
Imperial College, London
St George's Hospital, London
St Mary's/St Charles Hospital, London
King's/Maudsley Hospital, London
Royal Infirmary, Manchester
Correspondence: Sarah Byford, Centre for Health Economics, University of York, Heslington, York YO10 5DD
Declaration of interest Funded by the UK Department of Health and NHS Research and Development programme.
Background Intensive case management is commonly advocated for the care of the severely mentally ill, but evidence of its cost-effectiveness is lacking.
Aims To investigate the cost-effectiveness of intensive compared with standard case management for patients with severe psychosis.
Method 708 patients with psychosis and a history of repeated hospital admissions were randomly allocated to standard (case-loads 30-35) or intensive (case-loads 10-15) case management. Clinical and resource use data were assessed over two years.
Results No statistically significant difference was found between intensive and standard case management in the total two-year costs of care per patient (means £24 550 and £22 700, respectively, difference £1850, 95% Cl - £1600 to £5300). There was no evidence of differential effects in African-Caribbean patients or in the most disabled. Psychiatric in-patient hospital stay accounted for 47% of the total costs, but neither such hospitalisation nor other clinical outcomes differed between the randomised groups.
Conclusion Reduced case-loads have no clear beneficial effect on costs, clinical outcome or cost-effectiveness. The policy of advocating intensive case management for patients with severe psychosis is not supported by these results.
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