Cost-effectiveness in the treatment of patients with schizophrenia.

Three sorts of economic studies have addressed the treatment of schizophrenia. Studies of the total costs of the illness to whole communities have examined the economic effects of changes in both the illness and its treatment; naturalistic studies of cohorts of patients have addressed relationships between costs, needs and clinical outcomes; and randomized controlled trials of various kinds of community care and traditional care have produced data on the relative cost effectiveness of the new treatments. The Madison model of training in community living is generally cheaper for society than traditional care, consistently produces better satisfaction and, in some studies, has produced better clinical outcomes as well. Other models of care have produced similar outcomes at lower cost. A study that includes home-based rehabilitation for patients with established schizophrenic illness has produced better outcomes at similar costs. In general terms, cost savings are achieved by shortening the length of stay in hospital. Day care--often preceded by a short admission--has been shown to be cost-effective as an alternative to traditional hospitalization. The results of randomized control trials cannot be generalized to all those needing acute admission to hospital, since all studies have excluded many patients from the trials. There is some evidence that higher community costs are associated with better outcomes.