Cost-effectiveness of intensive v. standard case management for severe psychotic illness - UK700 case management trial

Background Intensive case management is commonly advocated for the care of- the severely mentally ill, but evidence of its cost-effectiveness is lackin g. Aims To investigate the cost-effectiveness of intensive compared with stand ard case management for patients with severe psychosis. Method 708 patients with psychosis and a history of repeated hospital admis sions were randomly allocated to standard (case-loads 30-35) or intensive ( case-loads 10-15) case management. Clinical and resource use data were asse ssed over two years. Results No statistically significant difference was found between intensive and standard case management in the total two-year costs of care per patie nt (means pound 24 550 and pound 22 700, respectively, difference pound 185 0, 95% Cl-pound 1600 to pound 5300). There was no evidence of differential effects in African-Caribbean patients or in the most disabled. Psychiatric in-patient hospital stay accounted for 47% of the total costs, but neither such hospitalisation nor other clinical outcomes differed between the rando mised groups. Conclusion Reduced case-loads have no clear beneficial effect on costs, cli nical outcome or cost-effectiveness. The policy of advocating intensive cas e management for patients with severe psychosis is not supported by these r esults. Declaration of interest Funded by the UK Department of Health and NHS Resea rch and Development programme.