Cost Utility of Intensive Home Treatment Compared With Acute Psychiatric Inpatient Admission.

IMPORTANCE

Intensive home treatment (IHT) is regarded as a safe and effective alternative to psychiatric inpatient care during acute crises.

OBJECTIVE

To estimate the cost-effectiveness of implementing IHT in comparison with inpatient treatment for persons with severe mental illness in acute crisis in the German health care system.

DESIGN, SETTING, AND PARTICIPANTS: This health economic evaluation was performed as part of a quasiexperimental nonrandomized trial conducted at 10 sites in Germany from January 2021 to December 2022. It included 200 patients with severe mental illness treated by IHT for acute crisis matched by means of propensity scores with 200 patients with severe mental illness receiving inpatient treatment. Participants were observed for 12 months. All analyses were conducted from January 15 to October 30, 2024.

MAIN OUTCOMES AND MEASURES

Incremental cost utility ratios (ICURs) were calculated for 12 months from the societal perspective and from the payer perspective of German statutory health insurance. ICUR uncertainty was estimated by nonparametric bootstrapping and estimated cost-effectiveness acceptability curves for maximum willingness to pay (MWTP) thresholds of €25 000 and €50 000.

RESULTS

The mean (SD) age of all 400 eligible study participants was 45 (16) years, and 264 (66%) were female. Overall, 374 were considered in the analysis. The ICUR point estimates were €48 786.43 from the perspective of statutory health insurance and €38 433.81 from the societal perspective. Acceptability rates for IHT being a cost-effective alternative compared with inpatient treatment from the societal perspective were 67% at an MWTP threshold of €25 000 and 50% at an MWTP of €50 000 and were 60% at an MWTP of €25 000 and 44% at an MWTP of €50 000 from the perspective of the statutory health insurance.

CONCLUSIONS AND RELEVANCE

This economic analysis found that IHT for persons with severe mental illness in acute crisis is expected to be cost-effective compared with inpatient treatment, with a slightly higher acceptability probability for statutory health insurance than for the economy as a whole. Due to the high stochastic uncertainty, the study results suggest that more research is needed to assess the economic efficiency of IHT more clearly.