Original Articles

The use of a Cumulative Needs for Care Monitor for individual treatment v. care as usual for patients diagnosed with severe mental illness, a cost-effectiveness analysis from the health care perspective

M. Drukker^a1 c1, M. Joore^a2a3, J. van Os^a1a4, S. Sytema^a5, G. Driessen^a1, M. Bak^a1 and Ph. Delespaul^a1a6

^a1 Department of Psychiatry and Psychology, School for Mental Health and NeuroScience MHeNS, Maastricht University, Maastricht, The Netherlands

^a2 Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands

^a3 Department of Health Services Research, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands

^a4 King's College London, King's Health Partners Department of Psychosis Studies, Institute of Psychiatry, London, UK

^a5 Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands

^a6 Integrated Care Division, Mondriaan, South-Limburg, Heerlen, The Netherlands

Abstract

To study the systematic assessment of need for care and clinical parameters for use in treatment plans in patients diagnosed with severe mental illness.

The Cumulative Needs for Care Monitor (CNCM) includes various validated instruments, such as the Camberwell Assessment of Need. A Markov-type cost-effectiveness model (health care perspective, 5-year time horizon) was used to compare CNCM with care as usual (CAU). Two studies were used to determine model parameters: a before–after study (n = 2155) and a matched-control study (n = 937).

The CNCM may lead to a gain in psychiatric functioning according to the models. CNCM patients remain in (outpatient) care, while CAU patients drop out more frequently. There is only a small difference in inpatient care. As a result, average costs per patient in the CNCM group are between €2809 (before–after model) and €5251 (matched-control model) higher. The iCER was between €45 127 and €57 839 per life year without psychiatric dysfunction gained.

CNCM may be only cost-effective when willingness to pay for a life year without psychiatric dysfunction is higher than €45 000. However, this result is highly sensitive to the level of psychiatric dysfunctioning in patients who do not receive care.

(Received September 19 2011)

(Revised March 15 2012)

(Accepted March 17 2012)

(Online publication May 22 2012)

Key words

• Assessments of health care needs;
• cost-effectiveness;
• functioning;
• psychotic disorders

Correspondence:

^c1 Address for correspondence: Dr Marjan Drukker, Department of Psychiatry and Psychology, School for Mental Health and NeuroScience MHeNS, Maastricht University, P.O. Box 616, location Vijverdal, 6200 MD Maastricht, The Netherlands. (Email: Marjan.Drukker@MaastrichtUniversity.nl)