Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-28T18:20:29.014Z Has data issue: false hasContentIssue false
  • English
  • Français

The use of a Cumulative Needs for Care Monitor for individual treatment v. care as usual for patients diagnosed with severe mental illness, a cost-effectiveness analysis from the health care perspective

Published online by Cambridge University Press:  22 May 2012

M. Drukker ,
M. Joore ,
J. van Os ,
S. Sytema ,
G. Driessen ,
M. Bak  and
Ph. Delespaul
M. Drukker*
Affiliation:
Department of Psychiatry and Psychology, School for Mental Health and NeuroScience MHeNS, Maastricht University, Maastricht, The Netherlands
M. Joore
Affiliation:
Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands Department of Health Services Research, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
J. van Os
Affiliation:
Department of Psychiatry and Psychology, School for Mental Health and NeuroScience MHeNS, Maastricht University, Maastricht, The Netherlands King's College London, King's Health Partners Department of Psychosis Studies, Institute of Psychiatry, London, UK
S. Sytema
Affiliation:
Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
G. Driessen
Affiliation:
Department of Psychiatry and Psychology, School for Mental Health and NeuroScience MHeNS, Maastricht University, Maastricht, The Netherlands
M. Bak
Affiliation:
Department of Psychiatry and Psychology, School for Mental Health and NeuroScience MHeNS, Maastricht University, Maastricht, The Netherlands
Ph. Delespaul
Affiliation:
Department of Psychiatry and Psychology, School for Mental Health and NeuroScience MHeNS, Maastricht University, Maastricht, The Netherlands Integrated Care Division, Mondriaan, South-Limburg, Heerlen, The Netherlands
*
*Address for correspondence: Dr Marjan Drukker, Department of Psychiatry and Psychology, School for Mental Health and NeuroScience MHeNS, Maastricht University, P.O. Box 616, location Vijverdal, 6200 MD Maastricht, The Netherlands. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Aims.

To study the systematic assessment of need for care and clinical parameters for use in treatment plans in patients diagnosed with severe mental illness.

Methods.

The Cumulative Needs for Care Monitor (CNCM) includes various validated instruments, such as the Camberwell Assessment of Need. A Markov-type cost-effectiveness model (health care perspective, 5-year time horizon) was used to compare CNCM with care as usual (CAU). Two studies were used to determine model parameters: a before–after study (n = 2155) and a matched-control study (n = 937).

Results.

The CNCM may lead to a gain in psychiatric functioning according to the models. CNCM patients remain in (outpatient) care, while CAU patients drop out more frequently. There is only a small difference in inpatient care. As a result, average costs per patient in the CNCM group are between €2809 (before–after model) and €5251 (matched-control model) higher. The iCER was between €45 127 and €57 839 per life year without psychiatric dysfunction gained.

Conclusions.

CNCM may be only cost-effective when willingness to pay for a life year without psychiatric dysfunction is higher than €45 000. However, this result is highly sensitive to the level of psychiatric dysfunctioning in patients who do not receive care.

Keywords

Assessments of health care needscost-effectivenessfunctioningpsychotic disorders
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 21 , Issue 4 , December 2012 , pp. 381 - 392
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aagaar, J, Nielsen, JA (2004). Experience from the first ACT programme in Denmark. II. Severe mental illness. A register diagnosis. Nord Journal of Psychiatry 58, 171–174.CrossRefGoogle ScholarPubMed
Briggs, A, Claxton, K, Sculpher, M (2007). Decision Modelling for Health Economic Evaluations. Oxford University Press: Oxford.Google Scholar
CBS (Statistics Netherlands) (2009). StatLine (http://statline.cbs.nl/). Accessed 2 October 2 2009.Google Scholar
Chisholm, D, Healey, A, Knapp, M (1997). QALYs and mental health care. Social Psychiatry and Psychiatric Epidemiology 32, 68–75.CrossRefGoogle ScholarPubMed
College voor Zorgverzekeringen (2006). Guidelines for pharmacoeconomic research, updated version. Richtlijnen voor farmaco-economisch onderzoek, geactualiseerde versie. Diemen.Google Scholar
College voor Zorgverzekeringen (2011). Medicijnkosten (http://www.medicijnkosten.nl). Accessed May 2011.Google Scholar
Council for Public Health and Health Care (2006). Sensible and Sustainable Care. Council for Public Health and Health Care: Zoetermeer.Google Scholar
Drukker, M, Van Dillen, K, Bak, M, Mengelers, R, Van Os, J, Delespaul, P (2008). The use of the Camberwell Assessment of Need in treatment: what unmet needs can be met? Social Psychiatry and Psychiatric Epidemiology 43, 410–417.Google Scholar
Drukker, M, Bak, M, Campo, J, Driessen, G, Van Os, J, Delespaul, PA (2010 a). The Cumulative Needs for Care Monitor (CNCM), a unique monitoring system in the South of The Netherlands. Social Psychiatry and Psychiatric Epidemiology 45, 475–485.Google Scholar
Drukker, M, Van Os, J, Bak, M, Campo, J, Delespaul, P (2010 b). Systematic monitoring of needs for care and global outcomes in patients with severe mental illness. BMC Psychiatry 10, 36.Google Scholar
Drukker, M, Van Os, J, Dietvorst, M, Sytema, S, Driessen, G, Delespaul, P (2011 a). Does monitoring need for care in patients diagnosed with severe mental illness impact on psychiatric service use? Comparison of monitored patients with matched controls. BMC Psychiatry 11, 45.CrossRefGoogle ScholarPubMed
Drukker, M, Van Os, J, Sytema, S, Driessen, G, Visser, E, Delespaul, P (2011 b). Function Assertive Community Treatment (FACT) and psychiatric service use in patients diagnosed with severe mental illness. Epidemiology and Psychiatric Sciences 20, 273–278.Google Scholar
Drukker, M, Visser, E, Sytema, S, Van Os, J (submitted). Flexible Assertive Community Treatment, severity of symptoms and psychiatric health service use.Google Scholar
Drummond, MF (2005). Methods for the Economic Evaluation of Health Care Programmes. Oxford University Press: Oxford.CrossRefGoogle Scholar
EuroQol Group (1990). EuroQol-a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy 16, 199–208.CrossRefGoogle Scholar
Evers, S, Salvador-Carulla, L, Halsteinli, V, Mcdaid, D, Mheen Group (2007). Implementing mental health economic evaluation evidence: building a bridge between theory and practice. Journal of Mental Health 16, 223–241.Google Scholar
Fenwick, E, Claxton, K, Sculpher, M (2001). Representing uncertainty: the role of cost-effectiveness acceptability curves. Health Economics 10, 779–787.Google Scholar
Gilbody, SM, House, AO, Sheldon, TA (2003). Outcome measures and needs assessment tools for schizophrenia and related disorders. Cochrane Database of Systrmatic Reviews, 10.1002/14651858.CD003081.CrossRefGoogle ScholarPubMed
Jones, SH, Thornicroft, G, Coffey, M, Dunn, G (1995). A brief mental health outcome scale-reliability and validity of the Global Assessment of Functioning (GAF). British Journal of Psychiatry 166, 654–659.Google Scholar
Killaspy, H, Banerjee, S, King, M, Lloyd, M (2000). Prospective controlled study of psychiatric out-patient non-attendance. Characteristics and outcome. British Journal of Psychiatry 176, 160–165.Google Scholar
Kong, CY, McMahon, PM, Gazelle, GS (2009). Calibration of disease simulation model using an engineering approach. Value Health 12, 521–529.Google Scholar
Konnopka, A, Gunther, OH, Angermeyer, MC, Konig, HH (2006). [Discriminative ability, construct validity and sensitivity to change of the EQ-5D quality of life questionnaire in paranoid schizophrenia] Diskriminationsvermögen, Konstruktvalidität und Veränderungssensitivität des EQ − 5D Lebensqualitäts − fragebogens bei paranoider Schizophrenie. Psychiatrische Praxis 33, 330–336.CrossRefGoogle Scholar
McCrone, P, Johnson, S, Nolan, F, Pilling, S, Sandor, A, Hoult, J, Mckenzie, N, Thompson, M, Bebbington, P (2009). Economic evaluation of a crisis resolution service: a randomised controlled trial. Epidemiologia e Psichiatria Sociale 18, 54–58.Google Scholar
McGrath, JJ (2006). Variations in the incidence of schizophrenia: data versus dogma. Schizophrenia Bulletin 32, 195–197.Google Scholar
Nasrallah, H, Tandon, R, Keshavan, M (2011). Beyond the facts in schizophrenia: closing the gaps in diagnosis, pathophysiology, and treatment. Epidemiology and Psychiatric Sciences 20, 317–327.Google Scholar
Oostenbrink, J, Bouwmans, C, Koopmanschap, M, Rutten, F (2004). [Manual for costs research] Handleiding voor kostenonderzoek; methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg. Geactualiseerde versie 2004. College voor zorgverzekeringen: Diemen.Google Scholar
Priebe, S, Mccabe, R, Bullenkamp, J, Hansson, L, Lauber, C, Martinez-Leal, R, Rossler, W, Salize, H, Svensson, B, Torres-Gonzales, F, Van Den Brink, R, Wiersma, D, Wright, DJ (2007). Structured patient-clinician communication and 1-year outcome in community mental healthcare: cluster randomised controlled trial. British Journal of Psychiatry 191, 420–426.Google Scholar
Priebe, S, Sinclair, J, Burton, A, Marougka, S, Larsen, J, Firn, M, Ashcroft, R (2010). Acceptability of offering financial incentives to achieve medication adherence in patients with severe mental illness: a focus group study. Journal of Medical Ethics 36, 463–468.Google Scholar
Pyne, JM, Rost, Km, Zhang, M, Williams, DK, Smith, J, Fortney, J (2003). Cost-effectiveness of a primary care depression intervention. Journal of General Internal Medicine 18, 432–441.CrossRefGoogle ScholarPubMed
Ramirez, A, Ekselius, L, Ramklint, M (2008). Axis V-Global Assessment of Functioning scale (GAF), further evaluation of the self-report version. European Psychiatry 23, 575–579.Google Scholar
Robert, PH, Michel, E, Van Os, J, Altamura, AC, Bobes, J, Gerlach, J, Hellewell, Js, Kasper, S, Nabel, D (2007). [2-COM: presentation of an instrument facilitating communication between physicians and carers in daily practice] 2-COM: presentation d'un instrument permettant de faciliter la communication entre medecin et soignants en pratique quotidienne. Encephale 33, 60–64.Google Scholar
Roick, C, Thierfelder, K, Heider, D, Klemm, T, Paschke, R, Angermeyer, MC (2004). [Quality of life instruments and health state preferences to assess effects of medical interventions for mentally and medically ill patients] Untersuchung der Aussagefähigkeit psychometrischer und präferenzbasierter Lebensqualitätindizes bei psychisch und somatisch Kranken. Psychiatrische Praxis 31, 128–137.Google Scholar
Schout, G, De Jong, G, Zeelen, J (2010). Establishing contact and gaining trust: an exploratory study of care avoidance. Journal of Advanced Nursing 66, 324–333.CrossRefGoogle ScholarPubMed
Sculpher, M (2008). NICE's 2008 methods guide: sensible consolidation or opportunities missed? Pharmacoeconomics 26, 721–724.Google Scholar
Slade, M, McCrone, P, Kuipers, E, Leese, M, Cahill, S, Parabiaghi, A, Priebe, S, Thornicroft, G (2006). Use of standardised outcome measures in adult mental health services: randomised controlled trial. British Journal of Psychiatry 189, 330–336.Google Scholar
Soderberg, P, Tungstrom, S, Armelius, BA (2005). Reliability of global assessment of functioning ratings made by clinical psychiatric staff. Psychiatric Services 56, 434–438.Google Scholar
Startup, M, Jackson, MC, Bendix, S (2002). The concurrent validity of the Global Assessment of Functioning (GAF). British Journal of Clinical Psychology 41, 417–422.Google Scholar
StataCorp (2009). Stata Statistical Software, 11th edn.Stata Corporation: College Station, TX.Google Scholar
Sytema, S, Wunderink, L, Bloemers, W, Roorda, L, Wiersma, D (2007). Assertive community treatment in the Netherlands; a randomized controlled trial. Acta Psychiatrica Scandinavica 116, 105–112.Google Scholar
Tungstrom, S, Soderberg, P, Armelius, BA (2005). Relationship between the Global Assessment of Functioning and other DSM axes in routine clinical work. Psychiatric Services 56, 439–443.Google Scholar
Van De Willige, G, Wiersma, D, Nienhuis, FJ, Enner, JA (2005). Changes in quality of life in chronic psychiatric patients: a comparison between EuroQol (EQ-5D) and WHOQoL. Quality of Life Research 14, 441–451.CrossRefGoogle ScholarPubMed
Van Hout, BA, Al, MJ, Gordon, GS, Rutten, FF (1994). Costs, effects and C/E-ratios alongside a clinical trial. Health Economics 3, 309–319.Google Scholar
Van Os, J, Triffaux, JM (2008). Evidence that the two-way communication checklist identifies patient-doctor needs discordance resulting in better 6-month outcome. Acta Psychiatrica Scandinavica 118, 322–326.Google Scholar
Van Os, J, Gilvarry, C, Bale, R, Van Horn, E, Tattan, T, White, I, Murray, R (1999). To what extent does symptomatic improvement result in better outcome in psychotic illness? UK700 Group. Psychological Medicine 29, 1183–1195.CrossRefGoogle ScholarPubMed
Van Os, J, Altamura, AC, Bobes, J, Gerlach, J, Hellewell, JS, Kasper, S, Naber, D, Robert, P (2004). Evaluation of the two-way communication checklist as a clinical intervention. Results of a multinational, randomised controlled trial. British Journal of Psychiatry 184, 79–83.Google Scholar
Van Veldhuizen, JR (2007). FACT: a Dutch version of ACT. Community Mental Health Journal 43, 421–433.Google Scholar
Vanni, T, Legood, R, White, RG (2010). Calibration of disease simulation model using an engineering approach. Value Health 13, 157.Google Scholar
Weinstein, MC (2006). Recent developments in decision-analytic modelling for economic evaluation. Pharmacoeconomics 24, 1043–1053.Google Scholar