Better care for less money: cost‐effectiveness of integrated care in multi‐episode patients with severe psychosis

OBJECTIVE: To compare cost-effectiveness of integrated care with therapeutic assertive community treatment (IC-TACT) versus standard care (SC) in multiple-episode psychosis. METHOD: Twelve-month IC-TACT in patients with schizophrenia-spectrum and bipolar I disorders were compared with a historical control group. Primary outcomes were entropy-balanced cost-effectiveness based on mental healthcare costs from a payers' perspective and quality-adjusted life years (QALYs) as a measure of health effects during 12-month follow-up. RESULTS: At baseline, patients in IC-TACT (n = 214) had significantly higher illness severity and lower functioning than SC (n = 56). Over 12 months, IC-TACT had significantly lower days in inpatient (10.3 +/- 20.5 vs. 28.2 +/- 44.9; P = 0.005) and day-clinic care (2.6 +/- 16.7 vs. 16.4 +/- 33.7; P = 0.004) and correspondingly lower costs (euro-55 084). Within outpatient care, IC-TACT displayed a higher number of treatment contacts (116.3 +/- 45.3 vs. 15.6 +/- 6.3) and higher related costs (euro+1417). Both resulted in lower total costs in IC-TACT (mean difference = euro-13 248 +/- 2975, P < 0.001). Adjusted incremental QALYs were significantly higher for IC-TACT versus SC (+0.10 +/- 0.37, P = 0.05). The probability of cost-effectiveness of IC-TACT was constantly higher than 99%. CONCLUSION: IC-TACT was cost-effective compared with SC. The use of prima facies 'costly' TACT teams is highly recommended to improve outcomes and save total cost for patients with severe psychotic disorders.