Cost-effectiveness of intensive home treatment enhanced by inpatient treatment elements in child and adolescent psychiatry in Germany: A randomised trial

Abstract

ISRCTN02672532, part 1, Current Controlled Trials Ltd, URL: http://www.controlled-trials.com).

Review: Alternatives to inpatient care for children and adolescents with mental health disorders

“…MST was more cost‐effective at reducing externalizing and internalizing behaviours from baseline to the completion of MST (Sheidow et al., ). Hot‐BITS was also associated with significantly lower cost than inpatient treatment between admission and 8 months follow‐up (Boege et al., ).…”

“…A variety of interventions were investigated as alternatives to inpatient treatment, including multisystemic therapy (MST; Henggeler et al., ), day patient treatment (Herpertz‐Dahlmann et al., ), specialist outpatient service (Gowers et al., ), intensive home treatment (Mattejat, Hirt, Wilken, Schmidt, & Remschmidt, ; Winsberg, Bialer, Kupietz, Botti, & Balka, ) and supported discharge service (SDS; Boege, Corpus, Schepker, Kilian, & Fegert, ) versus inpatient treatment. A total of 569 participants were randomized across the studies.…”

“…A total of 569 participants were randomized across the studies. Allocation concealment was adequate in three studies (Boege et al., ; Gowers et al., ; Herpertz‐Dahlmann et al., ) and unclear in three studies (Henggeler et al., ; Mattejat et al., ; Winsberg et al., ). The Jadad score was two for three studies (Henggeler et al., ; Mattejat et al., ; Winsberg et al., ) and it was three for three studies (Boege et al., ; Gowers et al., ; Herpertz‐Dahlmann et al., ).…”

“…Home treatment was better at providing improvement on all behavioural measures in patients with behavioural disorders only (Winsberg et al., ) and similar rate of improvement on emotional disorders and behavioural disorders (Mattejat et al., ). Despite significant improvements had been found with SDS in a pilot study (Ougrin, Zundel, Corrigall, Padmore, & Loh, ), there was no evidence that SDS was superior to inpatient care (Boege et al ., ). MST in young people with psychiatric emergencies was at least as effective, and in some cases more effective, than psychiatric hospitalization (Henggeler et al., ).…”

“…Several key characteristics of intensive community services were found to be important across most studies. All services were delivered at home or in the community (Boege et al., ; Gowers et al., ; Henggeler et al., ; Herpertz‐Dahlmann et al., ; Mattejat et al., ; Winsberg et al., ). When inpatient treatment was required, patients were discharged early and received subsequent treatment at home or in the community.…”