Cost-Effectiveness of a Multidisciplinary Lifestyle-Enhancing Treatment for Inpatients With Severe Mental Illness: The MULTI Study V

Abstract

Economic evaluations of lifestyle interventions for people with mental illness are needed to inform policymakers and managers about implementing such interventions and corresponding reforms in routine mental healthcare. We aimed to evaluate changes in healthcare costs 18 months after the implementation of a multidisciplinary lifestyle-enhancing treatment for inpatients with severe mental illness (MULTI) versus treatment as usual (TAU). In a cohort study (n=114; 65 MULTI, 49 TAU), we retrospectively retrieved cost data in Euros on all patient sessions, ward stay, medication use, and hospital referrals in the quarter year at the start of MULTI (Q1 2014) and after its evaluation (Q3 2015). We used linear regression analyses correcting for baseline values and differences between groups, calculated deterministic incremental cost-effectiveness ratios for previously shown changes in physical activity, metabolic health, psychosocial functioning and additionally quality of life, and performed probabilistic sensitivity analyses including cost-effectiveness planes. Adjusted regression showed reduced total costs per patient per quarter year in favor of MULTI (B=-736.30, 95%CI: -2145.2–672.6). Corresponding probabilistic sensitivity analyses accounting for uncertainty surrounding the parameters showed statistically non-significant cost savings against health improvements for all health-related outcomes in MULTI compared to TAU. It is concluded that MULTI did not increase healthcare costs while improving health outcomes. This indicates that starting lifestyle interventions does not need to be hampered by costs. Potential societal and economic value may justify investment to support implementation and maintenance. Further research is needed to study this hypothesis.

Cost-effectiveness analysis of physical activity interventions for people with schizophrenia or bipolar disorder: systematic review

“…Although physical activity should be encouraged for all people with schizophrenia or bipolar disorder, owing to resource constraints of healthcare systems the provision of a multicomponent lifestyle intervention including a PAI component might need to be limited to those people who are mostly likely to benefit from it. Based on the limited evidence, it is suggested that the following patient subgroups might be more likely to benefit from a multicomponent lifestyle intervention including a PAI component: men; 43 individuals with comorbid type 2 diabetes; 12 and individuals who have been psychiatric hospital in-patients for ≥1 year 42 . Further research is urgently needed to confirm the differential impacts of using multicomponent lifestyle interventions including a PAI component on different patient subgroups.…”

“…Table 1 summarises the characteristics of the nine included studies. All included studies were conducted in high-income countries: the UK (4/9, 44.4%), 12,13,37,38 the USA (2/9, 22.2%), 39,40 The Netherlands (2/9, 22.2%) 41,42 and Belgium (1/9, 11.1%). 43 The settings of the interventions were community mental health services (5/9, 55.6%), [37][38][39][40][41] primary care (2/9, 22.2%), 12,13 a sheltered housing organisation (1/9, 11.1%) 43 and in-patient care (1/9, 11.1%).…”

“…43 The settings of the interventions were community mental health services (5/9, 55.6%), [37][38][39][40][41] primary care (2/9, 22.2%), 12,13 a sheltered housing organisation (1/9, 11.1%) 43 and in-patient care (1/9, 11.1%). 42 Regarding the population, all included studies recruited people with a mixed diagnosis of mental disorders except Park, 12 which recruited only people with schizophrenia and comorbid type 2 diabetes mellitus. People with schizophrenia were included in all nine studies, whereas people with bipolar disorder were included in six studies.…”

The SMILE lifestyle intervention for people with a severe mental illness: feasibility and (cost-)effectiveness

“…To support decision-making in implementing lifestyle interventions, costeffectiveness evaluations are essential and, although a few studies have reported on these in mental health care, evidence is still scarce (40)(41)(42)(43)(44)(45). We therefore also conducted an economic evaluation alongside the trial investigating the costeffectiveness and cost-utility of the SMILE intervention with respect to usual care.…”

“…An increasing number of clinical guidelines for mental health care for people with SMI include a focus on physical health (4). Although many studies have been conducted (4,27), evidence for long-term sustainability of lifestyle interventions for people with SMI is still limited (40,57,151,152), and implementation into routine care is lacking (40,68). Also, little is known regarding the cost-effectiveness of lifestyle interventions within this population as studies often do not describe cost data or address cost-effectiveness (4,38,57,153).…”