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Effectiveness and cost-effectiveness of an integrated care program for schizophrenia: an analysis of routine data

  • Linda Kerkemeyer
  • Jürgen Wasem
  • Anja Neumann
  • Werner Brannath
  • Benjamin Mester
  • Jürgen Timm
  • Thomas Wobrock
  • Claudia Bartels
  • Peter Falkai
  • Janine Biermann
Original Paper
  • 309 Downloads

Abstract

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.

Keywords

Health economics evaluation Outpatient integrated care Routine data analysis Statutory health insurance Germany 

Notes

Compliance with ethical standards

Funding

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.

References

  1. 1.
    McGrath J, Saha S, Chant D, Welham J (2008) Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiol Rev 30:67–76CrossRefPubMedGoogle Scholar
  2. 2.
    Gaebel W, Wölwer W (2010) RKI Themenheft, Heft 50, Schizophrenie. Robert Koch-Institut, BerlinGoogle Scholar
  3. 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. 4.
    Federal Statistical Office (2008) Cost of illness for Germany. Federal Statistical Office, WiesbadenGoogle Scholar
  5. 5.
    Federal Statistical Office (2016) Hospital statistics—diagnostic data of patients in hospitals. Federal Statistical Office, WiesbadenGoogle Scholar
  6. 6.
    Ziguras SJ, Stuart GW (2000) A meta-analysis of the effectiveness of mental health case management over 20 years. Psychiatr Serv 51(11):1410–1421CrossRefPubMedGoogle Scholar
  7. 7.
    Björkman T, Hansson L, Sandlund M (2002) Outcome of case management based on the strengths model compared to standard care. A randomised controlled trial. Soc Psychiatry Psychiatr Epidemiol 37(4):147–152CrossRefPubMedGoogle Scholar
  8. 8.
    Burns T, Catty J, Dash M, Roberts C, Lockwood A, Marshall M (2007) Use of intensive case management to reduce time in hospital in people with severe mental illness: systematic review and meta-regression. BMJ 335:336CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Aagaard J, Müller-Nielsen K (2011) Clinical outcome of assertive community treatment (ACT) in a rural area in Denmark: a case-control study with a 2-year follow-up. Nord J Psychiatry 65:299–305CrossRefPubMedGoogle Scholar
  10. 10.
    Hastrup LH, Aagaard J (2015) Costs and outcome of assertive community treatment (ACT) in a rural area in Denmark: 4-year register-based follow-up. Nord J Psychiatry 69:110–117CrossRefPubMedGoogle Scholar
  11. 11.
    Dieterich M, Irving CB, Bergman H, Khokhar MA, Park B, Marshall M (2017) Intensive case management for severe mental illness. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD007906.pub3 PubMedCrossRefGoogle Scholar
  12. 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
  13. 13.
    Sungur M, Soygür H, Güner P, Üstün B, Cetin I, Falloon IR (2011) Identifying an optimal treatment for schizophrenia: a 2-year randomized controlled trial comparing integrated care to a high-quality routine treatment. Int J Psychiatry Clin Pract 15(2):118–127CrossRefPubMedGoogle Scholar
  14. 14.
    Alonso Suarez M, Bravo-Ortiz MF, Fernandez-Liria A, Gonzalez-Juarez C (2011) Effectiveness of continuity-of-care programs to reduce time in hospital in persons with schizophrenia. Epidemiol Psychiatr Sci 20(1):65–72CrossRefPubMedGoogle Scholar
  15. 15.
    Tempier R, Balbuena L, Garety PA, Craig TJ (2012) Does assertive community outreach improve social support? Results from the Lambeth study of early-episode psychosis. Psychiatr Serv 63(3):216–222CrossRefPubMedGoogle Scholar
  16. 16.
    Morrissey JP, Domino ME, Cuddeback GS (2013) Assessing the effectiveness of recovery-oriented ACT in reducing state psychiatric hospital use. Psychiatr Serv 64(4):303–311CrossRefPubMedGoogle Scholar
  17. 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. 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
  19. 19.
    McCrone P, Craig TJ, Power P, Garety PA (2010) Cost-effectiveness of an early intervention service for people with psychosis. Br J Psychiatry 196(5):377–382CrossRefPubMedGoogle Scholar
  20. 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
  21. 21.
    Zhang Z, Zhai J, Wei Q, Qi J, Guo X, Zhao J (2014) Cost-effectiveness analysis of psychosocial intervention for early stage schizophrenia in China: a randomized, one-year study. BMC Psychiatry. doi: 10.1186/s12888-014-0212-0 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Schmidt-Kraepelin C, Janssen B, Gaebel W (2009) Prevention of rehospitalization in schizophrenia: results of an integrated care project in Germany. Eur Arch Psychiatry Clin Neurosci 259:205–212CrossRefGoogle Scholar
  23. 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. 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
  25. 25.
    Bramesfeld A, Moock J, Kopke K, Büchtemann D, Kästner D, Radisch J, Rössler W (2013) Effectiveness and efficiency of assertive outreach for Schizophrenia in Germany: study protocol on a pragmatic quasi-experimental controlled trial. BMC Psychiatry. doi: 10.1186/1471-244X-13-56 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 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. 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

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Linda Kerkemeyer
    • 1
  • Jürgen Wasem
    • 1
  • Anja Neumann
    • 1
  • Werner Brannath
    • 2
  • Benjamin Mester
    • 2
  • Jürgen Timm
    • 2
  • Thomas Wobrock
    • 3
    • 4
  • Claudia Bartels
    • 4
  • Peter Falkai
    • 5
  • Janine Biermann
    • 1
  1. 1.Institute for Health Care Management and ResearchUniversity of Duisburg-EssenEssenGermany
  2. 2.Competence Centre for Clinical Trials/BiometryUniversity of BremenBremenGermany
  3. 3.Centre of Mental HealthCounty Hospitals Darmstadt-DieburgGroß-UmstadtGermany
  4. 4.Department of Psychiatry and PsychotherapyGeorg-August UniversityGöttingenGermany
  5. 5.Department of Psychiatry and PsychotherapyLudwig-Maximilians-UniversityMunichGermany

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