Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria.
Department of Psychiatry, Warneford Hospital, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, OX3 7JX, UK.
Soc Psychiatry Psychiatr Epidemiol. 2021 Jan;56(1):85-95. doi: 10.1007/s00127-020-01919-4. Epub 2020 Jul 27.
Current RCT and meta-analyses have not found any effect of community treatment orders (CTOs) on hospital or social outcomes. Assumed positive impacts of CTOs on quality-of-life outcomes and reduced hospital costs are potentially in conflict with patient autonomy. Therefore, an analysis of the cost and quality-of-life consequences of CTOs was conducted within the OCTET trial.
The economic evaluation was carried out comparing patients (n = 328) with psychosis discharged from involuntary hospitalisation either to treatment under a CTO (CTO group) or voluntary status via Section 17 leave (non-CTO group) from the health and social care and broader societal perspectives (including cost implication of informal family care and legal procedures). Differences in costs and outcomes defined as quality-adjusted life years (QALYs) based on the EQ-5D-3L or capability-weighted life years (CWLYs) based on the OxCAP-MH were assessed over 12 months (£, 2012/13 tariffs).
Mean total costs from the health and social care perspective [CTO: £35,595 (SD: £44,886); non-CTO: £36,003 (SD: £41,406)] were not statistically significantly different in any of the analyses or cost categories. Mental health hospitalisation costs contributed to more than 85% of annual health and social care costs. Informal care costs were significantly higher in the CTO group, in which there were also significantly more manager hearings and tribunals. No difference in health-related quality of life or capability wellbeing was found between the groups.
CTOs are unlikely to be cost-effective. No evidence supports the hypothesis that CTOs decrease hospitalisation costs or improve quality of life. Future decisions should consider impacts outside the healthcare sector such as higher informal care costs and legal procedure burden of CTOs.
目前的随机对照试验和荟萃分析并未发现社区治疗令（CTO）对医院或社会结果有任何影响。CTO 对生活质量结果的预期积极影响与患者自主权相冲突，可能会降低医院的成本。因此，在 OCTET 试验中对 CTO 的成本和生活质量结果进行了分析。
该经济评估从健康和社会护理以及更广泛的社会角度（包括非正式家庭护理和法律程序的成本影响），对因非自愿住院而出院的精神病患者（n=328）进行了比较，比较了他们接受 CTO 治疗（CTO 组）或通过第 17 条休假（非 CTO 组）接受自愿治疗的情况。根据 EQ-5D-3L 定义的差异在成本和结果（定义为质量调整生命年（QALYs））和基于 OxCAP-MH 的能力加权生命年（CWLYs）进行评估，为期 12 个月（£，2012/13 年费率）。
从健康和社会护理角度来看，CTO 组的总费用（£35595[SD：£44886]）和非 CTO 组（£36003[SD：£41406]）在任何分析或成本类别中均无统计学差异。精神卫生医院治疗费用占年度健康和社会护理费用的 85%以上。CTO 组的非正式护理费用明显较高，而且该组的经理听证和法庭审理也明显更多。两组的健康相关生活质量或能力健康均无差异。
CTO 不太可能具有成本效益。没有证据支持 CTO 可降低住院费用或改善生活质量的假设。未来的决策应考虑医疗保健部门以外的影响，例如非正式护理费用增加和 CTO 的法律程序负担。
