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Cost and Cost-effectiveness of Hospital vs Residential Crisis Care for Patients Who Have Serious Mental Illness
Wayne S. Fenton, MD;
Jeffrey S. Hoch, PhD;
James M. Herrell, PhD, MPH;
Loren Mosher, MD;
Lisa Dixon, MD, MPH
Arch Gen Psychiatry. 2002;59:357-364.
Background This study evaluates the cost and cost-effectiveness of a residential
crisis program compared with treatment received in a general hospital psychiatric
unit for patients who have serious mental illness in need of hospital-level
care and who are willing to accept voluntary treatment.
Methods Patients in the Montgomery County, Maryland, public mental health system
(N = 119) willing to accept voluntary acute care were randomized to the psychiatric
ward of a general hospital or a residential crisis program. Unit costs and
service utilization data were used to estimate episode and 6-month treatment
costs from the perspective of government payors. Episodic symptom reduction
and days residing in the community over the 6 months after the episode were
chosen to represent effectiveness.
Results Mean (SD) acute treatment episode costs was $3046 ($2124) in the residential
crisis program, 44% lower than the $5549 ($3668) episode cost for the general
hospital. Total 6-month treatment costs for patients assigned to the 2 programs
were $19 941 ($19 282) and $25 737 ($21 835), respectively.
Treatment groups did not differ significantly in symptom improvement or community
days achieved. Incremental cost-effectiveness ratios indicate that in most
cases, the residential crisis program provides near-equivalent effectiveness
for significantly less cost.
Conclusions Residential crisis programs may be a cost-effective approach to providing
acute care to patients who have serious mental illness and who are willing
to accept voluntary treatment. Where resources are scarce, access to needed
acute care might be extended using a mix of hospital, community-based residential
crisis, and community support services.
From the National Institute of Mental Health, Bethesda, Md (Dr Fenton);
Department of Epidemiology and Biostatistics and the Department of Family
Medicine University of Western Ontario School of Medicine and Dentistry, London
(Dr Hoch); Center for Substance Abuse Treatment, Division of Practice and
Systems Development, Substance Abuse and Mental Health Services Administration,
Rockville, Md (Dr Herrell); Soteria Associates, San Diego, Calif (Dr Mosher);
and the University of Maryland, Baltimore (Dr Dixon).
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