SERVICE USE AND COSTS OF HOME-BASED VERSUS HOSPITAL-BASED CARE FOR PEOPLE WITH SERIOUS MENTAL-ILLNESS

Background. The Daily Living Programme (DLP) offered problem-oriented, home-based care for people aged 17-64 with severe mental illness faci ng emergency admission to the Bethlem-Maudsley Hospital. The multidisc iplinary DLP team acted as direct provider and link with other service s. Each patient had a key worker. Cost-effectiveness was assessed. Met hod. The comprehensive costs of DLP and standard in-patient care were compared within a randomised controlled trial. Cost measures ranged ov er all service inputs and living expenses. The costs of informal care and lost employment were also considered. Assessments Of service use, costs and outcomes were conducted at referral, 4, 11 and 20 months. Re sults. The DLP was significantly less costly than standard treatment i n both short and medium term (P=0.000). Cost savings accrued almost ex clusively to the NHS, with no other agency's costs being higher. Concl usions. Coupled with mildly encouraging outcome results over the 20 mo nth period, the DLP was clearly cost-effective in this medium term.