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Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 20, Issue 3, 2017. Pages: 101-110
Published Online: 1 September 2017

Copyright © 2017 ICMPE.


 

Cost-effectiveness Analysis of an Aftercare Service vs Treatment-As-Usual for Patients with Severe Mental Disorders

Eshagh Barfar,1 Vandad Sharifi,2 Homayoun Amini,2 Yasaman Mottaghipour,3 Masud Yunesian,4 Mehdi Tehranidoost,2 Payam Sobhebidari2 and Arash Rashidian5*

1Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
2M.D., Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
3Ph.D., Department of Psychiatry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4MD, Ph.D., Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
5MD, Ph.D., Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

*Correspondence to: Arash Rashidian, M.D., Ph.D., Department of Health Management and Economics, 4th Floor, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Tel: +98-21-88991112
Fax: +98-21-88991113
E-mail: arashidian@tums.ac.ir; arash.rashidian@gmail.com

Source of Funding: The study was funded by the Mental Health Office at the Ministry of Health and Tehran University of Medical Sciences.

Abstract

It had been suggested that community mental health programs are effective in improving health and functioning in patients with severe mental health disorders and are efficient. We assessed the cost-effectiveness of an Aftercare Service when compared with Treatment-As-Usual for patients with severe mental disorders in Iran. A total of 160 post-discharge eligible patients were randomized into two equal patient groups: Aftercare Service vs Treatment-As-Usual, and patients were followed for 12 months after discharge. The main outcome measures were the rate of readmission at the hospitals after discharge. The costs were assessed from a societal perspective. There was no significant difference in patient outcomes between the two groups. The Aftercare Service intervention in total was about 66,000 USD cheaper than Treatment-As-Usual intervention. Since the aftercare service was a cost-effective service delivery mode, our results suggest that the aftercare service can be recommended as an efficient service delivery mode in middle-income countries.

 

Background: There have been claims that community mental health principles leads to the maintenance of better health and functioning in patients and can be more economical for patients with severe and chronic mental disorders. Economic evaluation studies have been used to assess the cost-effectiveness of national health programs, or to propose efficient strategies for health care delivery.

Aims of the Study: The current study is intended to test the cost-effectiveness of an Aftercare Service when compared with Treatment-As-Usual for patients with severe mental disorders in Iran.

Methods: This study was a parallel group randomized controlled trial. A total of 160 post-discharge eligible patients were randomized into two equal patient groups, Aftercare Service (that includes either Home Visiting Care, or Telephone Follow-up for outpatient treatment) vs Treatment-As-Usual, using stratified balanced block randomization method. All patients were followed for 12 months after discharge. The perspective of the present study was the societal perspective. The outcome measures were the rate of readmission at the hospitals after discharge, psychotic symptoms, manic symptoms, depressive symptoms, illness severity, global functioning, quality of life, and patients' satisfaction with the services. The costs included the intervention costs and the patient and family costs in the evaluation period.

Results: There was no significant difference in effectiveness measures between the two groups. The Aftercare Service arm was about 66,000 US$ cheaper than Treatment-As-Usual arm. The average total cost per patient in the Treatment-As-Usual group was about 4651 US$, while it was reduced to 3823 US$ in the Aftercare Service group; equivalent to a cost reduction of about 800 US$ per patient per year.

Discussion and Limitations: Given that there was no significant difference in effectiveness measures between the two groups (slightly in favor of the intervention), the Aftercare Service was cost-effective. The most important limitation of the study was the relatively small sample size due to limited budget for the implementation of the study. A larger sample size and longer follow-ups are warranted.

Implications for Health Care Provision, Use and Policies: Considering the limited resources and equity concerns for health systems, the importance of making decisions about healthcare interventions based on cost-effectiveness evidence is increasing. Our results suggest that the aftercare service can be recommended as an efficient service delivery mode, especially when psychiatric bed requirements are insufficient for a population.

Implications for Further Research: Further research should continue the work done with a larger sample size and longer follow-ups to further establish the cost-effectiveness analysis of an aftercare service program compared with routine conventional care.

Received 10 May 2016; accepted 11 July 2017

Copyright 2017 ICMPE