INTENSIVE CASE-MANAGEMENT - A COST-EFFECTIVENESS ANALYSIS

Objective: The objective of this study was to compare the outcomes and costs of intensive case management with routine case management for a group of severely disabled patients with a mental illness. Method: A cost-effectiveness analysis was conducted alongside a randomised contr olled trial. Seventy-three patients, who reside in the eastern suburbs of Sydney, were randomly allocated to either intensive or routine cas e management. Staff providing intensive case management had substantia lly lower caseloads than staff providing routine case management. The main health outcome measured was patients' level of functioning as mea sured by the Life Skills Profile. Costing data were collected from hos pital services, mental health services, general health services, commu nity services and informal carers. Results: At 12 months, outcome and costing data were analysed on 58 patients and hospitalisation data wer e analysed on 68 patients. Significantly more patients in the intensiv e case management group remained in treatment (chi(2) = 6.00, df = 1, p < 0.01) and showed a clinically significant improvement in functioni ng from baseline to 12 months (chi(2) = 4.50, df = 1, p < 0.05). The m ean cost per patient was $7745 more in the intensive group than in the routine group (t = 1.49, df = 56, p > 0.01) over 12 months. The cost- effectiveness ratio indicated a cost of $27661 per year for one additi onal patient in the intensive case management group to make a clinical ly significant improvement in functioning. Conclusion: Intensive case management led to an increased rate of retention in treatment and a cl inically significant improvement in functioning. Further comparative c ost-effectiveness studies are required to determine whether $27661 per year for one patient to make a clinically significant improvement in functioning is a cost-effective use of mental health resources.