Maeng Daniel, Tsun Zhi-Yang, Lesch Eric, Jacobowitz David B, Strawderman Robert L, Harrington Donald K, Li Yue, Weisman Robert L, Lamberti J Steven
Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York.
Psychiatr Serv. 2023 Apr 1;74(4):358-364. doi: 10.1176/appi.ps.20220186. Epub 2022 Sep 6.
In this study, the authors assessed return on investment (ROI) associated with a forensic assertive community treatment (FACT) program.
A retrospective secondary data analysis of a randomized controlled trial comprising 70 legal-involved patients with severe mental illness was conducted in Rochester, New York. Patients were randomly assigned to receive either FACT or outpatient psychiatric treatment including intensive case management. Unit of service costs associated with psychiatric emergency department visits, psychiatric inpatient days, and days in jail were obtained from records of New York State Medicaid and the Department of Corrections. The total dollar value difference between the two trial arms calculated on a per-patient-per-year (PPPY) basis constituted the return from the FACT intervention. The FACT investment cost was defined by the total additional PPPY cost associated with FACT implementation relative to the control group. ROI was calculated by dividing the return by the investment cost.
The estimated return from FACT was $27,588 PPPY (in 2019 dollars; 95% confidence interval [CI]=$3,262-$51,913), which was driven largely by reductions in psychiatric inpatient days, and the estimated investment cost was $18,440 PPPY (95% CI=$15,215-$21,665), implying an ROI of 1.50 (95% CI=0.35-2.97) for FACT.
The Rochester FACT program was associated with approximately $1.50 return for every $1 spent on its implementation, even without considering potential returns from other sources, including reductions in acute medical care, crime-related damages, and public safety costs. ROI estimates were highly dependent on context-specific factors, particularly Medicaid reimbursement rates for assertive community treatment and hospital stays.
在本研究中，作者评估了与法医积极社区治疗（FACT）项目相关的投资回报率（ROI）。
在纽约罗切斯特对一项随机对照试验进行回顾性二次数据分析，该试验纳入了70名涉及法律问题的重度精神疾病患者。患者被随机分配接受FACT或包括强化个案管理在内的门诊精神科治疗。与精神科急诊科就诊、精神科住院天数和监禁天数相关的服务成本单位来自纽约州医疗补助计划和惩教部的记录。在每位患者每年（PPPY）的基础上计算两个试验组之间的总美元价值差异，构成FACT干预的回报。FACT投资成本由相对于对照组实施FACT相关的额外PPPY总成本定义。通过将回报除以投资成本来计算ROI。
FACT的估计回报为每年每位患者27,588美元（2019年美元；95%置信区间[CI] = 3,262美元 - 51,913美元），这主要是由于精神科住院天数的减少，估计投资成本为每年每位患者18,440美元（95% CI = 15,215美元 - 21,665美元），这意味着FACT的ROI为1.50（95% CI = 0.35 - 2.97）。
罗切斯特FACT项目每投入1美元实施，大约可获得1.50美元的回报，即使不考虑其他来源的潜在回报，包括急性医疗护理减少、犯罪相关损害和公共安全成本的降低。ROI估计高度依赖于特定背景因素，特别是积极社区治疗和住院治疗的医疗补助报销率。
