HOME-BASED VERSUS HOSPITAL-BASED CARE FOR SERIOUS MENTAL-ILLNESS - CONTROLLED COST-EFFECTIVENESS STUDY OVER 4 YEARS

Background The Daily Living Programme (DLP) offered intensive home-bas ed care with problem-centred case management for seriously mentally il l people facing crisis admission to the Maudsley Hospital, London. The cost effectiveness of the DLP was examined over four years. Method A randomised controlled study examined cost-effectiveness of DLP versus standard in/out-patient hospital care over 20 months, followed by a ra ndomised controlled withdrawal of half the DLP patients into standard care. Three patient groups were compared over 45 months: DLP throughou t the period, DLP for 20 months followed by standard care. and standar d care throughout. Bivariate and multivariate analyses were conducted (the latter to standardise for possible inter-sample differences stemm ing from sample attrition and to explore sources of within-sample vari ation). Results The DLP was more cost-effective than control care over months 1-20. and also over the full 45-month period, but the differen ce between groups may have disappeared by the end of month 45. Conclus ions The reduction of the cost-effectiveness advantage for home-based care was perhaps partly due to the attenuation of DLP care, although s ample attrition left some comparisons under-powered.