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Cost-Effectiveness of 12-Month Therapeutic Assertive Community Treatment as Part of Integrated Care Versus Standard Care in Patients With Schizophrenia Treated With Quetiapine Immediate Release (ACCESS Trial)

J Clin Psychiatry 2012;73(3):e402-e408
10.4088/JCP.11m06875

Objective: To compare the 1-year cost-effectiveness of therapeutic assertive community treatment (ACT) with standard care in schizophrenia. ACT was specifically developed for patients with schizophrenia, delivered by psychosis experts highly trained in respective psychotherapies, and embedded into an integrated care system.

Method: Two catchment areas in Hamburg, Germany, with similar population size and health care structures were assigned to offer 12-month ACT (n = 64) or standard care (n = 56) to 120 first- and multiple-episode patients with schizophrenia spectrum disorders (DSM-IV), the latter with a history of relapse due to medication nonadherence. Primary outcome was the incremental cost-effectiveness ratio (ICER) based on mental health care costs from a payer perspective and quality-adjusted life-years (QALYs) as a measure of health effects during the 12-month follow-up period (2006–2007).

Results: ACT was associated with significantly lower inpatient but higher outpatient costs than standard care, resulting in nonsignificantly lower total costs (P = .27). Incremental QALYs in the ACT group were 0.1 (P < .001). Thus, the point estimate for the ICER showed dominance of ACT. The probability of an ICER below €50,000 per QALY gained was 99.5%.

Conclusions: The implementation of a psychotherapeutically oriented schizophrenia-specific and -experienced ACT team led to an improved patient outcome with reduced need of inpatient care. Despite the introduction of such a rather “costly” ACT team, treatment in ACT was cost-effective with regard to improved quality of life at comparable yearly costs.

Trial Registration: ClinicalTrials.gov identifier: NCT01081418

J Clin Psychiatry 2012;73(3):e402–e408

Submitted: January 21, 2011; accepted June 20, 2011(doi:10.4088/JCP.11m06875).

Corresponding author: Anne Karow, MD, Psychosis Centre, Department for Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20246 Hamburg, Germany (karow@uke.de).