Cost-effectiveness of care for people with psychosis in the community and psychiatric hospitals in the Czech Republic: an economic analysis

Abstract

Background The absence of economic evidence hinders current reforms of hospital based mental health systems in Central and Eastern Europe. We aimed to assess the costeffectiveness of care for people with chronic psychoses in psychiatric hospitals compared to discharging patients to the community in the Czech Republic. Methods We conducted a prospective study of people with chronic psychotic disorders and evaluated the impact associated with discharge into community services as compared to not discharging people from psychiatric hospitals at baseline in the Czech Republic. We measured utilization of services, health related quality of life, met and unmet needs, and global functioning using an adapted Client Services Receipt Inventory (CSRI), EQ-5D-5L, Camberwell Assessment of Need (CAN) and General Assessment of Functioning (GAF). Adjusting for baseline differences between the two groups, we assessed differences in societal costs in Euros (€) and QALYs over a year-long follow-up which we then used to estimate the incremental cost-effectiveness ratio (ICER). We conducted multiple sensitivity analyses to assess the robustness of our results. Outcomes In our base case scenario, we included 115 patients who were either inpatient or community services users at the baseline. The two groups were very similar in terms of their observed characteristics. The annual QALY was 0.77 and 0.80 in the group discharged to the community at the baseline compared to not being discharged (difference 0.03 95% confidence interval-0.04 to 0.1), but costs were €8,503 compared to €16,425 (difference €7,922, 95% confidence interval 4,371 to 11,472) such that the ICER reached over 250,000 € per QALY. This is considerably above levels that are conventionally considered to be costeffective and the estimated probability that discharge to the community was cost-effective was very high. None of the sensitivity analyses changed these results qualitatively. Interpretation This study provides economic evidence for deinstitutionalization by showing that discharge to community care is cost-effective when compared to care in psychiatric hospitals in the Czech Republic. Thus, it adds to the human rights-and clinical-based arguments for mental health care reforms in Central and Eastern Europe.

Increase in prevalence of current mental disorders in the context of COVID-19: analysis of repeated nationwide cross-sectional surveys

“…As this study includes only community-dwelling participants, it might be argued that some confounding might occur because of an increased number of individuals with mental illness being based in the community. However this is largely unlikely as the target population for deinstitutionalisation are patients with psychosis (Winkler et al ., 2018 b ), which were not included in the current study, and at most, patients with comorbidities in mental health diagnosis could be represented and contribute to the increased prevalence of people with mental illness in 2020 as compared to the 2017 baseline sample.…”

Correlates of internalized stigma levels in people with psychosis in the Czech Republic

“…This cross-sectional study was nested into a year-long longitudinal study (Kondrátová, König, Mladá, & Winkler, 2019; Winkler et al, 2018) measuring the cost and outcomes of psychosis. Data were collected during the second measurement, out of four conducted within the study.…”

Expenditures on Mental Health Care in the Czech Republic in 2015

“…To illustrate this disproportionality in respect to a particular industry, whereas the said disorders accounted only for 19% of patients in psychiatric hospitals, they consumed 35% of the hospitals' budget. Another recent study [28] moreover shows that the costs of community care for these disordersand for other non-affective psychosesare significantly lower than the costs of their inpatient care (about 350 thousand CZK per patient) while being similarly effective. Schizophrenia, schizotypal and delusional disorders thus appear to be apt candidates for deinstitutionalization of the care [10,29].…”