The British Journal of Psychiatry (2000) 177: 370-371
© 2000 The Royal College of Psychiatrists
Comments on the UK700 case management trial
D. J. Castle
University of Western Australia and Fremantle Hospital & Health
Service, Alma Street, Fremantle 6160, Western Australia
EDITED BY MATTHEW HOTOPF
The UK700 Group (2000)
presents a comparative cost analysis of intensive case management (ICM)
v. standard case management for patients with severe mental illness.
It failed to find any significant difference in duration of in-patient
treatment between the two groups at 2 years, and the cost of care was thus
roughly equal. The authors conclude that "the policy of advocating
intensive case management for all patients with severe psychosis is not
supported....".
While the execution of the UK700 study is admirable in terms of its sheer
number of subjects, the design is critically restricted by the very nature of
the ‘intensive case management’ offered. Indeed, the mean number
of contacts per client was 100 (s.d.=64) v. 64 (s.d.=30) in the
control group; this equates to around one visit per week and one per
fortnight, respectively. Comparison with our local (ICM) service shows that
our case managers visit clients far more regularly than this (daily, if
necessary). While this might seem excessive, it appears that it is crucial to
maintaining such patients in the community, and is ultimately cost-effective.
Indeed, Preston & Fazio
(2000) showed that for our ICM
service, with a capped case-load per case worker of around 10 patients, and a
mean number of annual community contacts of 164 (s.d.=20) v. 56
(s.d.=100) for non-intensive patients, in-patient bed-days fell dramatically
(from a mean of 118 days (s.d.=113) per year before ICM, to 57 days (s.d.=91)
in the second year of the ICM intervention). The control group showed no such
reduction in bed-days, and the overall cost saving (factoring in the increased
out-patient costs for the ICM group) at the end of the 2 years was AU$801 475
for 65 patients (P <0.001).
Thus, it is important that the precise nature of the intervention is
examined before dismissing ICM as a cost-effective model of service
delivery.
REFERENCES
Preston, N. J. & Fazio, S. (2000)
Establishing the efficacy and cost effectiveness of community intensive case
management of long-term mentally ill: a matched control group study.
Australian and New Zealand Journal of Psychiatry,
34,
114-121.[Medline]
UK700 Group (2000) Cost-effectiveness of
intensive v. standard case management for severe psychotic illness.
UK700 case management trial. British Journal of
Psychiatry, 176,
537-543.[Abstract/Free Full Text]
