Roland Ricken1, Katja Wiethoff2, Thomas Reinhold3, Thomas J Stamm4, Thomas C Baghai5, Robert Fisher6, Florian Seemüller7, Peter Brieger8, Joachim Cordes9, Gerd Laux10, Iris Hauth11, Hans-Jürgen Möller12, Andreas Heinz2, Michael Bauer13, Mazda Adli14. 1. Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany. Electronic address: roland.ricken@charite.de. 2. Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany. 3. Charité - Universitätsmedizin Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Campus Charité Mitte, Berlin, Germany. 4. Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany; Brandenburg Medical School Theodor Fontane, Department of Psychiatry and Psychotherapy, Neuruppin, Germany. 5. University of Regensburg, Department of Psychiatry and Psychotherapy, Regensburg, Germany. 6. East London NHS Foundation Trust, City and Hackney Centre for Mental Health, Donald Winnicott Centre, London, United Kingdom. 7. kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany. 8. kbo-Isar-Amper-Klinikum, Munich, Germany. 9. Heinrich-Heine-University of Düsseldorf, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany. 10. Institut für Psychologische Medizin, Haag, Germany. 11. Alexianer St. Joseph-Krankenhaus Berlin-Weißensee, Department of Psychiatry and Psychotherapy, Berlin, Germany. 12. Ludwig-Maximilians-Universität München, Department of Psychiatry and Psychotherapy, Munich, Germany. 13. Technical University of Dresden, University Hospital Carl Gustav Carus Dresden, Department of Psychiatry and Psychotherapy, Dresden, Germany. 14. Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany; Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine, Berlin, Germany.
Abstract
BACKGROUND: In a previous single center study we found that a standardized drug treatment algorithm (ALGO) was more cost effective than treatment as usual (TAU) for inpatients with major depression. This report aimed to determine whether this promising initial finding could be replicated in a multicenter study. METHODS: Treatment costs were calculated for two time periods: the study period (from enrolment to exit from study) and time in hospital (from enrolment to hospital discharge) based on daily hospital charges. Cost per remitted patient during the study period was considered as primary outcome. RESULTS: 266 patients received ALGO and 84 received TAU. For the study period, ALGO costs were significantly lower than TAU (ALGO: 7 848 ± 6 065 €; TAU: 10 033 ± 7 696 €; p = 0.04). For time in hospital, costs were not different (ALGO: 14 734 ± 8 329 €; TAU: 14 244 ± 8 419 €; p = 0.617). Remission rates did not differ for the study period (ALGO: 57.9%, TAU: 50.0%; p=0.201). Remission rates were greater in ALGO (83.3%) than TAU (66.2%) for time in hospital (p = 0.002). Cost per remission was lower in ALGO (13 554 ± 10 476 €) than TAU (20 066 ± 15 391 €) for the study period (p < 0.001) and for time in hospital (ALGO: 17 582 ± 9 939 €; TAU: 21 516 ± 12 718 €; p = 0.036). LIMITATIONS: Indirect costs were not assessed. Different dropout rates in TAU and ALGO complicated interpretation. CONCLUSIONS: Treatment algorithms enhance the cost effectiveness of the care of depressed inpatients, which replicates our prior results in an independent sample.
BACKGROUND: In a previous single center study we found that a standardized drug treatment algorithm (ALGO) was more cost effective than treatment as usual (TAU) for inpatients with major depression. This report aimed to determine whether this promising initial finding could be replicated in a multicenter study. METHODS: Treatment costs were calculated for two time periods: the study period (from enrolment to exit from study) and time in hospital (from enrolment to hospital discharge) based on daily hospital charges. Cost per remitted patient during the study period was considered as primary outcome. RESULTS: 266 patients received ALGO and 84 received TAU. For the study period, ALGO costs were significantly lower than TAU (ALGO: 7 848 ± 6 065 €; TAU: 10 033 ± 7 696 €; p = 0.04). For time in hospital, costs were not different (ALGO: 14 734 ± 8 329 €; TAU: 14 244 ± 8 419 €; p = 0.617). Remission rates did not differ for the study period (ALGO: 57.9%, TAU: 50.0%; p=0.201). Remission rates were greater in ALGO (83.3%) than TAU (66.2%) for time in hospital (p = 0.002). Cost per remission was lower in ALGO (13 554 ± 10 476 €) than TAU (20 066 ± 15 391 €) for the study period (p < 0.001) and for time in hospital (ALGO: 17 582 ± 9 939 €; TAU: 21 516 ± 12 718 €; p = 0.036). LIMITATIONS: Indirect costs were not assessed. Different dropout rates in TAU and ALGO complicated interpretation. CONCLUSIONS: Treatment algorithms enhance the cost effectiveness of the care of depressed inpatients, which replicates our prior results in an independent sample.