Cost-effectiveness of home treatment compared to inpatient care in child and adolescent psychiatry: evidence from a pilot trial.

چکیده اصلی

STUDY AIMS: Mental disorders in children and adolescents have increased substantially, placing growing pressure on healthcare systems. Home treatment has emerged as an alternative to conventional inpatient treatment as usual (I-TAU), potentially offering clinical and cost benefits. This study aimed to evaluate the cost-effectiveness of an intensive home treatment programme (AT_HOME) compared to I-TAU in Switzerland. METHODS: Data were collected within a monocentric pilot trial involving 75 children and adolescents (aged 6-17 years) admitted for acute psychiatric care between May 2019 and July 2020. Participants were allocated to AT_HOME if they met geographical and safety criteria and consented to receive home treatment (n = 27); all remaining patients received I-TAU (n = 48). Clinical effectiveness was assessed as between-group differences in change in psychosocial functioning from admission to follow-up at 18-24 months, assessed with the Global Assessment of Functioning (GAF) scale. The primary outcome of this secondary analysis was the cost-effectiveness of home treatment compared with I-TAU. Cost estimates included direct medical costs for the initial treatment period and follow-up healthcare utilisation from a comprehensive multi-payer healthcare system perspective. Cost-effectiveness was analysed using incremental cost-effectiveness ratios (ICER) and cost-effectiveness acceptability curves (CEAC). Secondary outcomes included the costs of the index treatment, costs of follow-up mental healthcare utilisation and total costs. RESULTS: The point estimate of the incremental cost of home treatment compared to I-TAU was CHF -48,591 (95% CI: -108,493 to 11,312; SE: 30,563) and the incremental effect was 9.41 (95% CI: 0.52 to 18.31; SE: 4.54) on the GAF scale. The resulting ICER was -5161 per 1-point improvement in the GAF score (95% CI: - 49,482 to 39,161; SE: 22,613) and the CEAC suggested a high probability (94.6%) that home treatment was cost-effective compared with I-TAU across willingness-to-pay thresholds. CONCLUSIONS: In this pilot trial, home treatment for children and adolescents with severe psychiatric disorders was associated with favourable cost-effectiveness estimates compared with I-TAU. These findings suggest that intensive home-based treatment models may have the potential to contribute to more efficient use of mental health resources. CLINICAL TRIAL REGISTRATION NUMBER: DRKS00025424 (German Clinical Trials Register, registered on 27 May 2021).

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