PubMed2006
BACKGROUND: Mental health policies, advocating outpatient as well as community mental health care for the severely mentally ill, are aiming towards health system cost containment and patient quality of life. Programs with cognitive behavioral therapy, such as the Integrated Psychological Therapy (IPT), added to standard medical therapy for patients with schizophrenia have been associated with improved outcomes. A Quebec version of the IPT program was integrated in outpatient clinics and improvements were observed in overall symptoms, subjective experiences, cognitive and social functioning, and quality of life. In light of these results we deemed it relevant to describe the health system cost and patient resource use associated with the program. The costs related to IPT have not been previously reported and this study will elucidate on effective health services and budget allocation needed to include IPT. AIMS: To describe health care resource use and related costs associated with participating in an IPT program included as standard medical therapy in nine clinical settings. METHODS: A cohort of patients with schizophrenia participating in the IPT program were followed up to one year preceding the start of the program and concurrently until the end to compare the resource use and costs incurred by patients with schizophrenia during their participation. A health and social service system and patient perspective was adopted, and the medical and non-medical costs associated with the IPT program were measured. Valuation (2001 CDN dollars) was based on information provided by provincial billing systems. Statistical differences were assessed using the Wilcoxon signed-rank test. RESULTS: The IPT program induced a one time fixed cost (2347 dollars) for the training of mental health professionals and costs related to patient participation (1350 dollars). Our results show that there was an average decrease in health care system resource use per patient during the IPT program (26,133 dollars) as opposed to the preceding year (26,750 dollars). There was a significant decrease in the number of visits and in physician fees paid out to psychiatrists, the number of hospitalizations and related costs, and visits to the emergency department per patient during the IPT program as compared to the preceding year. No significant difference was observed in patient related costs which averaged 7295 dollars and 7537 dollars, before and during the IPT program, respectively. DISCUSSION: Although the IPT program induces a one time fixed cost for training, the integration of IPT, as part of an individualized standard medical therapy, is associated with a change from inpatient towards outpatient resource use with no significant increase in health system related costs. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Given clinical and quality of life improvements, the findings suggest that offering IPT to more patients with severe mental illness may prove more cost beneficial by decreasing the health system related costs per user in the long term. IMPLICATIONS FOR FURTHER RESEARCH: Additional research is needed to examine in parallel the long-term clinical and cost impact of the IPT program in different clinical settings (young adults to long term mentally ill). This will elucidate to which patient population IPT is most cost-effective.