Institute for Health Care Management and Research, University of Duisburg-Essen, Thea-Leymann-Straße 9, 45127, Essen, Germany.
Competence Centre for Clinical Trials/Biometry, University of Bremen, Linzer Straße 4, 28359, Bremen, Germany.
Eur Arch Psychiatry Clin Neurosci. 2018 Sep;268(6):611-619. doi: 10.1007/s00406-017-0830-x. Epub 2017 Aug 8.
In Germany, a regional social health insurance fund provides an integrated care program for patients with schizophrenia (IVS). Based on routine data of the social health insurance, this evaluation examined the effectiveness and cost-effectiveness of the IVS compared to the standard care (control group, CG). The primary outcome was the reduction of psychiatric inpatient treatment (days in hospital), and secondary outcomes were schizophrenia-related inpatient treatment, readmission rates, and costs. To reduce selection bias, a propensity score matching was performed. The matched sample included 752 patients. Mean number of psychiatric and schizophrenia-related hospital days of patients receiving IVS (2.3 ± 6.5, 1.7 ± 5.0) per quarter was reduced, but did not differ statistically significantly from CG (2.7 ± 7.6, 1.9 ± 6.2; p = 0.772, p = 0.352). Statistically significant between-group differences were found in costs per quarter per person caused by outpatient treatment by office-based psychiatrists (IVS: €74.18 ± 42.30, CG: €53.20 ± 47.96; p < 0.001), by psychiatric institutional outpatient departments (IVS: €4.83 ± 29.57, CG: €27.35 ± 76.48; p < 0.001), by medication (IVS: €471.75 ± 493.09, CG: €429.45 ± 532.73; p = 0.015), and by psychiatric outpatient nursing (IVS: €3.52 ± 23.83, CG: €12.67 ± 57.86, p = 0.045). Mean total psychiatric costs per quarter per person in IVS (€1117.49 ± 1662.73) were not significantly lower than in CG (€1180.09 ± 1948.24; p = 0.150). No statistically significant differences in total schizophrenia-related costs per quarter per person were detected between IVS (€979.46 ± 1358.79) and CG (€989.45 ± 1611.47; p = 0.084). The cost-effectiveness analysis showed cost savings of €148.59 per reduced psychiatric and €305.40 per reduced schizophrenia-related hospital day. However, limitations, especially non-inclusion of costs related to management of the IVS and additional home treatment within the IVS, restrict the interpretation of the results. Therefore, the long-term impact of this IVS deserves further evaluation.
在德国，一家地区性的社会健康保险公司为精神分裂症患者（IVS）提供了综合护理方案。基于社会健康保险的常规数据，本评估研究了 IVS 与标准护理（对照组，CG）相比的有效性和成本效益。主要结果是减少精神科住院治疗（住院天数），次要结果是与精神分裂症相关的住院治疗、再入院率和成本。为了减少选择偏差，进行了倾向评分匹配。匹配样本包括 752 名患者。接受 IVS 治疗的患者（每季度 2.3±6.5 天，1.7±5.0 天）的精神病住院和与精神分裂症相关的住院天数有所减少，但与 CG 相比无统计学差异（2.7±7.6 天，1.9±6.2 天；p=0.772，p=0.352）。在每季度每人的门诊治疗费用方面，发现了组间统计学显著差异，由坐诊精神病医生（IVS：74.18±42.30 欧元，CG：53.20±47.96 欧元；p<0.001）、精神病机构门诊（IVS：4.83±29.57 欧元，CG：27.35±76.48 欧元；p<0.001）、药物（IVS：471.75±493.09 欧元，CG：429.45±532.73 欧元；p=0.015）和精神科门诊护理（IVS：3.52±23.83 欧元，CG：12.67±57.86 欧元，p=0.045）引起。IVS 每季度每人的精神科总治疗费用（1117.49±1662.73 欧元）与 CG（1180.09±1948.24 欧元）相比没有显著降低（p=0.150）。IVS（979.46±1358.79 欧元）和 CG（989.45±1611.47 欧元）之间每季度每人与精神分裂症相关的总成本没有统计学显著差异（p=0.084）。成本效益分析显示，每减少 1 天精神科和 1 天精神分裂症相关住院治疗，成本分别节省 148.59 欧元和 305.40 欧元。然而，限制因素，尤其是未纳入 IVS 管理和 IVS 内额外家庭治疗相关的成本，限制了对结果的解释。因此，该 IVS 的长期影响值得进一步评估。
