OBJECTIVE: To investigate the cost effectiveness of joint crisis plans, a form of advance agreement for people with severe mental illness. DESIGN: Single blind randomised controlled trial. SETTING:Eight community mental health teams in southern England. PARTICIPANTS: 160 people with a diagnosis of psychotic illness or non-psychotic bipolar disorder who had been admitted to hospital at least once within the previous two years. INTERVENTION: Joint crisis plan formulated by the patient, care coordinator, psychiatrist, and project worker containing contact information, details of illnesses, treatments, relapse indicators, and advance statements of preferences for care for future relapses. Control group was standardised service information. MAIN OUTCOME MEASURES: Admission to hospital; service use over 15 months. RESULTS: Use of a joint crisis plan was associated with less service use and lower costs on average than in the standardised service information group, but differences were not significant. Total costs during follow-up were 7264 pounds sterling (10,616 euros, 13,560 dollars) for each participant with a joint crisis plan and 8359 pounds sterling (12,217 euros, 15,609 dollars) for each participant with standardised service information (mean difference 1095 pounds sterling; 95% confidence interval -2814 to 5004). Cost effectiveness acceptability curves, used to explore uncertainty in estimates of costs and effects, suggest there is a greater than 78% probability that joint crisis plans are more cost effective than standardised service information in reducing the proportion of patients admitted to hospital. CONCLUSION: Joint crisis plans produced a non-significant decrease in admissions and total costs. Though the cost estimates had wide confidence intervals, the associated uncertainty suggests there is a relatively high probability of the plans being more cost effective than standardised service information for people with psychotic disorders.
RCT Entities:
OBJECTIVE: To investigate the cost effectiveness of joint crisis plans, a form of advance agreement for people with severe mental illness. DESIGN: Single blind randomised controlled trial. SETTING: Eight community mental health teams in southern England. PARTICIPANTS: 160 people with a diagnosis of psychotic illness or non-psychotic bipolar disorder who had been admitted to hospital at least once within the previous two years. INTERVENTION: Joint crisis plan formulated by the patient, care coordinator, psychiatrist, and project worker containing contact information, details of illnesses, treatments, relapse indicators, and advance statements of preferences for care for future relapses. Control group was standardised service information. MAIN OUTCOME MEASURES: Admission to hospital; service use over 15 months. RESULTS: Use of a joint crisis plan was associated with less service use and lower costs on average than in the standardised service information group, but differences were not significant. Total costs during follow-up were 7264 pounds sterling (10,616 euros, 13,560 dollars) for each participant with a joint crisis plan and 8359 pounds sterling (12,217 euros, 15,609 dollars) for each participant with standardised service information (mean difference 1095 pounds sterling; 95% confidence interval -2814 to 5004). Cost effectiveness acceptability curves, used to explore uncertainty in estimates of costs and effects, suggest there is a greater than 78% probability that joint crisis plans are more cost effective than standardised service information in reducing the proportion of patients admitted to hospital. CONCLUSION: Joint crisis plans produced a non-significant decrease in admissions and total costs. Though the cost estimates had wide confidence intervals, the associated uncertainty suggests there is a relatively high probability of the plans being more cost effective than standardised service information for people with psychotic disorders.
Authors: K Sutherby; G I Szmukler; A Halpern; M Alexander; G Thornicroft; C Johnson; S Wright Journal: Acta Psychiatr Scand Date: 1999-07 Impact factor: 6.392
Authors: A D Stant; S Castelein; R Bruggeman; J T van Busschbach; M van der Gaag; H Knegtering; D Wiersma Journal: Community Ment Health J Date: 2009-03-24
Authors: Paul Moran; Rohan Borschmann; Clare Flach; Barbara Barrett; Sarah Byford; Joanna Hogg; Morven Leese; Kim Sutherby; Claire Henderson; Diana Rose; Mike Slade; George Szmukler; Graham Thornicroft Journal: Trials Date: 2010-02-23 Impact factor: 2.279
Authors: Graham Thornicroft; Simone Farrelly; Max Birchwood; Max Marshall; George Szmukler; Waquas Waheed; Sarah Byford; Graham Dunn; Claire Henderson; Helen Lester; Morven Leese; Diana Rose; Kim Sutherby Journal: Trials Date: 2010-11-05 Impact factor: 2.279
Authors: Claire Henderson; Simone Farrelly; Paul Moran; Rohan Borschmann; Graham Thornicroft; Max Birchwood; The Crimson Journal: World Psychiatry Date: 2015-10 Impact factor: 49.548