Cost-Effectiveness of Crisis Resolution Home Treatment for Managing Acute Psychiatric Crises in Southern Switzerland

TL;DR

This study evaluates if home treatment for acute psychiatric crises is more cost-effective than hospitalization in southern Switzerland.

Contribution

The study provides the first formal cost-effectiveness evaluation of CRHT versus hospitalization in Switzerland.

Findings

CRHT was generally less costly than hospitalization.

CRHT showed high cost-effectiveness in the follow-up phase.

Cost-effectiveness varied depending on the type of psychiatric symptoms.

Abstract

This study aimed at providing the first formal cost-effectiveness evaluation of Crisis Resolution Home Treatment (CRHT) compared to hospitalization for the management of acute psychiatric crises in Switzerland.

Intervention (CRHT) and control (hospital) groups were formed based on patients’ place of residence according to a quasi-experimental design. Patients were followed starting from an acute episode of care until 2 years after discharge. Effectiveness measures were variation of psychiatric symptoms between admission and discharge and number of non-readmission days. Direct costs were obtained from the Cantonal Psychiatric Clinic and patients’ health insurance companies. Indirect costs were estimated based on sick leave certificates. Bootstrap resampling procedures and Cost-Effectiveness Acceptability Curves were used to assess cost differences between groups and cost-effectiveness.

CRHT resulted generally less costly than hospitalization. In the treatment phase, cost-effectiveness depended on the type of psychiatric symptoms considered, while CRHT resulted highly cost-effective in the follow-up phase.

CRHT can be a cost-effective alternative to hospitalization for managing acute psychiatric crises in Ticino. Further research is needed to explore patients’ conditions and characteristics associated with cost-effectiveness.

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