Costs and outcome of assertive community treatment (ACT) in a rural area in Denmark: 4-year register-based follow-up.
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.
['Hastrup|Lene Halling|LH|', 'Aagaard|Jørgen|J|']
D000328:Adult D000368:Aged D000553:Ambulatory Care D003156:Community Mental Health Services D003718:Denmark D005260:Female D005500:Follow-Up Studies D017048:Health Care Costs D006801:Humans D008297:Male D001523:Mental Disorders D008605:Mental Health Services D008875:Middle Aged D010043:Outcome and Process Assessment, Health Care D010352:Patient Dropouts D012042:Registries D019035:Rural Health Services D016896:Treatment Outcome
Costs Assertive community treatment Economic evaluation Severe mental illness