Canaway Alastair, Appleton Rebecca, van Bodegom Larissa, Dieleman Gwen, Franić Tomislav, Gerritsen Suzanne, de Girolamo Giovanni, Maras Athanasios, McNicholas Fiona, Overbeek Mathilde, Paul Moli, Purper-Ouakil Diane, Santosh Paramala, Schulze Ulrike, Singh Swaran P, Street Cathy, Tah Priya, Tremmery Bie, Tuomainen Helena, Verhulst Frank C, Wolke Dieter, Madan Jason
Centre for Health Economics at Warwick, Warwick Medical School, University of Warwick, UK.
NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK.
BJPsych Open. 2023 Sep 26;9(5):e175. doi: 10.1192/bjo.2023.559.
The boundary between services for children and adolescents and adults has been identified as problematic for young people with mental health problems.
To examine the use and cost of healthcare for young people engaged in mental healthcare before and after the child/adolescent and adult service boundary.
Data from 772 young people in seven European countries participating in the MILESTONE trial were analysed. We analysed and costed healthcare resources used in the 6-month period before and after the service boundary.
The proportion of young people engaging with healthcare services fell substantially after crossing the service boundary (associated costs €7761 pre-boundary €3376 post-boundary). Pre-boundary, the main cost driver was in-patient care (approximately 50%), whereas post-boundary costs were more evenly spread between services; cost reductions were correlated with pre-boundary in-patient care. Severity was associated with substantially higher costs pre- and post-boundary, and those who were engaged specifically with mental health services after the service boundary accrued the greatest healthcare costs post-service boundary.
Costs of healthcare are large in this population, but fall considerably after transition, particularly for those who were most severely ill. In part, this is likely to reflect improvement in the mental health of young people. However, qualitative evidence from the MILESTONE study suggests that lack of capacity in adult services and young people's disengagement with formal mental health services post-transition are contributing factors. Long-term data are needed to assess the adverse long-term effects on costs and health of this unmet need and disengagement.
儿童青少年与成人服务之间的界限已被认定为对有心理健康问题的年轻人存在问题。
研究跨越儿童/青少年与成人服务界限前后，参与心理保健的年轻人的医疗保健使用情况及成本。
对来自七个欧洲国家参与里程碑试验的772名年轻人的数据进行分析。我们分析并计算了跨越服务界限前后6个月期间所使用的医疗资源及成本。
跨越服务界限后，使用医疗保健服务的年轻人比例大幅下降（界限前相关成本为7761欧元，界限后为3376欧元）。界限前，主要成本驱动因素是住院治疗（约50%），而界限后成本在各项服务之间分布更为均匀；成本降低与界限前的住院治疗相关。严重程度在界限前后均与显著更高的成本相关，且那些在跨越服务界限后专门接受心理健康服务的人在服务界限后产生的医疗保健成本最高。
该人群的医疗保健成本很高，但过渡后大幅下降，尤其是对那些病情最严重的人。这在一定程度上可能反映了年轻人心理健康状况的改善。然而，里程碑研究的定性证据表明，成人服务能力不足以及年轻人在过渡后脱离正规心理健康服务是促成因素。需要长期数据来评估这种未满足的需求和脱离接触对成本和健康的长期不利影响。
