Costs and outcome of assertive community treatment (ACT) in a rural area in Denmark: 4-year
register-based follow-up
Engelsk titel: Costs and outcome of assertive community treatment (ACT) in a rural area in Denmark: 4-year
register-based follow-up
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Författare:
Halling Hastrup, Lene
;
Aagaard, Jörgen
Email: lhhs@regionsjaelland.dk
Språk: Eng
Antal referenser: 28
Dokumenttyp:
Artikel
UI-nummer: 15023302
Sammanfattning
Purpose: Health economic evidence of assertive community treatment (ACT) in Denmark is limited.
The aim of the study was to assess the costs and outcome of ACT among 174 patients with severe
and persistent mental illness in a rural area of Denmark. Methods: The study was based on a quasi-
experimental design with a control group from the neighbouring region. Costs and retention in mental
health services were analysed by using register data 1 year before and 4 years after inclusion in the
study. Data on the use of supportive housing were available for the year before baseline and the
subsequent 2 years only. Results: Seventy eight percent of the patients receiving ACT were in
contact with psychiatric services at the 4-year follow-up, while 69% of the patients in the control group
had contact with psychiatric services (P < 0.17). Days in supportive housing were lower for the ACT
group before baseline and remained so (dropping to zero) for the subsequent 2 years. Over 4 years,
the mean total costs per patient in the group receiving ACT were DDK 493,442 (SE = 34,292).
Excluding costs of supportive housing, the mean total costs per patient of the control group were DDK
537,218 (SE = 59,371), P < 0.53. If these costs are included, however, the mean total costs for the
ACT group are unchanged, whereas costs for the control group rise to DDK 671,500 (SE = 73,671), P <
0.03. Conclusion: While ACT appears to have resulted in a significant reduction in costs for
psychiatric hospitalizations, baseline differences in use of supportive housing make the effects of
ACT on overall costs more ambiguous. At worst, however, overall costs did not increase. Given the
generally acknowledged clinical benefits of ACT over standard outpatient care, the results support
further dissemination of ACT in Denmark.