The cost-utility of a community mental health care intervention over 24 months in Germany

During the last two decades the several evaluation studies on the effectiveness of community mental health care interventions (CMHC) have been conducted. However, in spite of the important role of economic outcomes for decision makers, the cost-utility of CMHC has been rarely investigated so far.

In this study the cost-utility of a community mental health care intervention for people with severe mental disorders in addition to routine care over 24 months will be investigated on the background of the German health and social care system.

In a randomized controlled trial 927 persons were assigned to the GBV intervention (n = 470) or to care as usual CAU (n = 457). Assessments were made at baseline and four follow-ups over 24 months. Quality adjusted life years were estimated on the basis of health states defined by the EuroQol EQ-5D-5L and the German value set. Comprehensive costs of illness (COI) were estimated by means of the Client Sociodemographic and Service Receipt Inventory (CSSRI) adjusted to the German health and social care system. An incremental cost-utility analysis (ICUA) from the societal perspective was conducted by means of the net-benefit approach. Stochastic uncertainty of the incremental cost-utility ratio (ICUR) was estimated by means of nonparametric bootstrapping with 10.000 replications. Results were interpreted on the basis of the cost-effectiveness acceptability curve(CEAC)  and the net monetary benefit regression curve using a maximum willingness to pay (MWtP) threshold range between 0 and € 125.000.

Results of the CUA reveal an increase of QALYs by 0.038 at increased costs of € 286,13 resulting in an ICUR of € 7,529.75 for the 24 month period. The CEAC indicates that a 95% probability of cost-effectiveness would be reached at a MWTP > € 125.000 which would not be appraised as cost-effective on the background of suggestions for national MWtP thresholds.