Effectiveness and cost-effectiveness of an integrated care program for schizophrenia: an analysis of routine data
In Germany, a regional social health insurance fund provides an integrated care program for patients with schizophrenia (IVS). Based on routine data of the social health insurance, this evaluation examined the effectiveness and cost-effectiveness of the IVS compared to the standard care (control group, CG). The primary outcome was the reduction of psychiatric inpatient treatment (days in hospital), and secondary outcomes were schizophrenia-related inpatient treatment, readmission rates, and costs. To reduce selection bias, a propensity score matching was performed. The matched sample included 752 patients. Mean number of psychiatric and schizophrenia-related hospital days of patients receiving IVS (2.3 ± 6.5, 1.7 ± 5.0) per quarter was reduced, but did not differ statistically significantly from CG (2.7 ± 7.6, 1.9 ± 6.2; p = 0.772, p = 0.352). Statistically significant between-group differences were found in costs per quarter per person caused by outpatient treatment by office-based psychiatrists (IVS: €74.18 ± 42.30, CG: €53.20 ± 47.96; p < 0.001), by psychiatric institutional outpatient departments (IVS: €4.83 ± 29.57, CG: €27.35 ± 76.48; p < 0.001), by medication (IVS: €471.75 ± 493.09, CG: €429.45 ± 532.73; p = 0.015), and by psychiatric outpatient nursing (IVS: €3.52 ± 23.83, CG: €12.67 ± 57.86, p = 0.045). Mean total psychiatric costs per quarter per person in IVS (€1117.49 ± 1662.73) were not significantly lower than in CG (€1180.09 ± 1948.24; p = 0.150). No statistically significant differences in total schizophrenia-related costs per quarter per person were detected between IVS (€979.46 ± 1358.79) and CG (€989.45 ± 1611.47; p = 0.084). The cost-effectiveness analysis showed cost savings of €148.59 per reduced psychiatric and €305.40 per reduced schizophrenia-related hospital day. However, limitations, especially non-inclusion of costs related to management of the IVS and additional home treatment within the IVS, restrict the interpretation of the results. Therefore, the long-term impact of this IVS deserves further evaluation.
KeywordsHealth economics evaluation Outpatient integrated care Routine data analysis Statutory health insurance Germany
Compliance with ethical standards
This scientific evaluation study was funded by the Management Company and the Federal Association of the AOK (AOK-Bundesverband).
Conflict of interest
T. Wobrock was honorary speaker for Alpine Biomed, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, I3G, Janssen-Cilag, Novartis, Lundbeck, Sanofi-Aventis, Otsuka, Roche, and Pfizer, and longer than 5 years ago he has accepted travel or hospitality funds not related to a speaking engagement from AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen-Cilag, and Sanofi-Synthelabo; and he has received a research grant from AstraZeneca, Cerbomed, I3G and AOK (health insurance company), the German Research Foundation (DFG), and the German Ministry of Education and Research (BMBF). He is a member of the advisory board of Janssen-Cilag and Otsuka/Lundbeck. W. Brannath has been consultant and iDMC member for Novartis Pharma AG, Roche, and Boehringer Ingelheim Pharma GmbH & Co. KG. The other authors have declared that there are no conflicts of interest in relation to the subject of this study.
- 2.Gaebel W, Wölwer W (2010) RKI Themenheft, Heft 50, Schizophrenie. Robert Koch-Institut, BerlinGoogle Scholar
- 3.Wobrock T, Weinmann S, Falkai P, Gaebel W (2006) Evidenzbasierte Psychiatrie—die S3-Therapieleitlinie Schizophrenie der DGPPN. Die Psychiatrie - Grundlagen und Perspektiven. Springer, BerlinGoogle Scholar
- 4.Federal Statistical Office (2008) Cost of illness for Germany. Federal Statistical Office, WiesbadenGoogle Scholar
- 5.Federal Statistical Office (2016) Hospital statistics—diagnostic data of patients in hospitals. Federal Statistical Office, WiesbadenGoogle Scholar
- 12.Kerkemeyer L, Mostardt S, Biermann J, Wasem J, Neumann A, Walendzik A, Jahn R, Bartels C, Falkai P, Brannath W, Breunig-Lyriti V, Mester B, Timm J, Wobrock T (2015) Evaluation of an integrated care program for schizophrenia: concept and study design. Eur Arch Psychiatry Clin Neurosci 265:155–162CrossRefPubMedGoogle Scholar
- 17.Sigrúnarson V, Grawe RW, Morken G (2013) Integrated treatment vs. treatment-as-usual for recent onset schizophrenia; 12 year follow-up on a randomized controlled trial. BMC Psychiatry. doi: 10.1186/1471-244X-13-200
- 18.Chatterjee S, Naik S, Joh S, Dabholkar H, Balaji M, Koschorke M, Varghese M, Thara R, Weiss HA, Paul W, McCrone P, Patel V, Thornicroft G (2014) Effectiveness of a community-based intervention for people with schizophrenia and their caregivers in India (COPSI): a randomised controlled trial. Lancet 383:1385–1394CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Hastrup LH, Kronborg C, Bertelsen M, Jeppesen P, Jorgensen P, Petersen L, Thorup A, Simonsen E, Nordentoft M (2013) Cost-effectiveness of early intervention in first-episode psychosis: economic evaluation of a randomised controlled trial (the OPUS study). Br J Psychiatry 202(1):35–41CrossRefPubMedGoogle Scholar
- 23.Lambert M, Bock T, Schöttle D, Golks D, Meister K, Rietschel L, Bussopulos A, Frieling M, Schödlbauer M, Burlon M, Huber CG, Ohm G, Pakrasi M, Chirazi-Stark MS, Naber D, Schimmelmann BG (2010) Assertive community treatment as part of integrated care versus standard care: a 12-month trial in patients with first- and multiple-episode schizophrenia spectrum disorders treated with quetiapine immediate release. J Clin Psychiatry 71(10):1313–1323CrossRefPubMedGoogle Scholar
- 24.Schöttle D, Schimmelmann BG, Karow A, Ruppelt F, Sauerbier AL, Bussopulos A, Frieling M, Golks D, Kerstan A, Nika E, Schödlbauer M, Daubmann A, Wegscheider K, Lange M, Ohm G, Lange B, Meigel-Schleiff C, Naber D, Wiedemann K, Bock T, Lambert M (2014) Effectiveness of integrated care including therapeutic assertive community treatment in severe schizophrenia spectrum and bipolar I disorders: the 24-month follow-up ACCESS II study. J Clin Psychiatry 75(12):1371–1379CrossRefPubMedGoogle Scholar
- 26.Karow A, Reimer J, König H-H, Heider D, Bock T, Huber C, Schöttle D, Meister K, Rietschel L, Ohm G, Schulz H, Naber D, Schimmelmann BG, Lambert M (2012) Cost-effectiveness of 12-month therapeutic assertive community treatment as part of integrated care versus standard care in patients with schizophrenia treated with quetiapine immediate release (ACCESS trial). J Clin Psychiatry 73(3):e402–e408CrossRefPubMedGoogle Scholar
- 27.Rosenheck R, Leslie D, Sint K, Lin H, Robinson DG, Schooler NR, Mueser KT, Penn DL, Addington J, Brunette MF, Correll CU, Estroff SE, Marcey P, Robinson J, Severe J, Rupp A, Schoenbaum M, Kane J (2016) Cost-effectiveness of comprehensive, integrated care for first episode psychosis in the NIMH RAISE early treatment program. Schizophr Bull 42(4):896–906CrossRefPubMedPubMedCentralGoogle Scholar