Cost-Effectiveness of Home Health Care vs Usual Care in Patients with Schizophrenia by Multidisciplinary Team of Donmoddaeng District Health Service Network in Ubonratchathani
Article Sidebar
Main Article Content
Abstract
Objective: To determine cost-effectiveness of home health care (HHC) vs usual care (UC) in patients with schizophrenia by multidisciplinary team of Donmoddaeng district health service network in Ubonratchathani using a societal perspective. Methods: An alongside clinical trial economic evaluation was conducted based on a randomized controlled trial of 60 schizophrenia patients (30 in HHC group and 30 in UC group). Both groups received usual care at the hospital. HHC group received home visits by multidisciplinary team for 3 times. Study outcomes were recurrence symptom, hospitalization and utility score measured by EQ-5D-5L questionnaire and visual analog scale (VAS). Study costs included HHC costs and treatment costs including direct medical, direct non-medical and indirect costs during 6 months from July to December 2019. Incremental cost-effectiveness ratio (ICER) was calculated and one-way sensitivity analysis was applied. Results: Most patients were male (60% in HHC group vs. 63% in UC group), aged >30 years (93% vs. 67%), living with family (77% vs. 90%), diagnosed schizophrenia >5 years (73% vs. 53%). HHC group had lower recurrence symptom (0% vs. 16.67%, P=0.020) and hospitalization (0% vs. 13.33%, P=0.038) compared with UC group. Increased utility scores were 11.00+10.86 in HHC group and 9.50+9.13 in UC group (P=0.697). Average cost of home visits was 3,588.45 baht/patient. Average total costs were 8,502.97 baht/patient in HHC group and 6,004.41 baht/patient in UC group. ICERs were 14,988.36 baht/reduced recurrence case, 18,743.89 baht/reduced hospitalization case and 181,615.33 baht/QALY gained. Sensitivity analysis case demonstrated that HHC would be cost-effective when reducing home visit cost by 20%. Conclusion: HHC in schizophrenia patients by multidisciplinary team is effective and would be cost-effective when reducing its cost. Therefore, health organizations should support this proactive health care service.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
References
Howes OD, Murray RM. Schizophrenia: an integrated sociodevelopmental-cognitive model. Lancet 2014 ; 383: 1677-87.
Anon. Department of Mental Health urges society to accept people with schizophrenia [online]. 2017 [cited April 18, 2018]. Available from: www.mati chon.co.th/news-monitor/news_566377.
World Health Organization. The world health report 2001: mental health new understanding, new hope. Geneva: Word Health Organization; 2001.
Wattanasiri O, Sripusito S. The development of continuity care in schizophrenia patient by interdis ciplinary team and care giver network of Kamphaeng Phet hospital. Journal of Nursing Division 2013; 40:67-83.
Chaiyalap S, Viriyakosol A. Home visit to patients with mental illness in the community after returning to society. Kuakarun Journal of Nursing 2014; 21: 139-54.
National Health Security Office. Fund management manual national health security 2018. Bangkok: National Health Security Office; 2017.
Tsai SL, Chen MB, Yin TJ. A comparison of the cost-effectiveness of hospital-based home care with that of a conventional outpatient follow-up for patients with mental illness. J Nurs Res 2005; 13: 165-73.
Zhang Z, Zhai J, Wei Q, Qi J, Guo X, Zhao J. Cost-effectiveness analysis of psychosocial intervention for early stage schizophrenia in China: a randomized, one-year study. BMC Psychiatry 2014; 14: 212. doi: 10.1186/s12888-014-0212-0
Chuamthong T. Factors related to drug deficiency of recurrent schizophrenia patients in Chonburi Hospital. [online]. 2011 [cite Mar 12, 2019]. Available from: kb.hsri.or.th/dspace/bitstream/hand l e/11228/3610/Tassanee.pdf?sequence=2&isAllow ed=y.
Siritheptawee M, Wattanagaroon P, Suravarangkul J, Chumsuk K, Dudsedeeprasert J, Witoonchart P. Cost-effectiveness analysis of continuity of care system in severe mental illness high risk to violence patients at primary care setting vs routine service system. Ramathibodi Medical Journal 2018; 41: 25-35.
National Health Security Fund. Handbook of community care for chronic psychiatric patients for primary care workers [online]. 2015 [cited Oct 7, 2018]. Available from: www.nhso.go.th/files/user files/file/Download/20160226/240259%20NEW.
Department of Mental Health Ministry of Public Health. Depression and suicide assessment [online]. 2018 [cited Oct 7, 2018]. Available from: www.dmh.go.th/test/download/view.asp?id=22.
Botha UA, Koen L, Joska JA, Hering LM, Oosthuizen PP. Assessing the efficacy of a modified assertive community-based treatment programme in a developing country. BMC Psychiatry 2010; 10: 73. doi: 10.1186/1471-244X-10-73.
Lertnarkorn S. A randomized controlled trial of weight control program for management of weight gain associated with atypical antipsychotics based regimen in schizophrenia patients (master thesis] Songkhla: Prince of Songkla University; 2007.
Tantachanya P, Promduang S, Thadsri W. Effect of brief intervention in patients with schizophrenia in psychiatric ward at Surin Hospital. Surin: Surin Hospital; 2015.
Suriyawong J, Khamwongpin M, Piyatakul N, Phusopha O, Simawong C, Kaewma P, et al. Handbook of self-care for schizophrenia. Chiang Mai: Suan Prung Hospital; 2009:3-15.
Pattanapha C. EQ-5D-5L health life quality question naire [online]. 017 [cited Mar 12, 2019]. Available from ccpe.pharmacycouncil.org/index.php?option= article_detail & subpage =article_detail & id = 416.
Patithad P. Quality Inspection of research instru ments. In: Training to create young researchers. Bangkok: Bansomdejchaopraya Rajabhat Univer sity; 2016. p.1-55.
Chaikredkaew A, Thaworncharoensap M, Riewpai boon A, Youngkong S, Tantai N, Meeyai AC, et al. Sensitivity analysis. In: Phannarunothai S, Pilasan S, Sangsri W, Kingkaew P, editors. Guideline for health technology assessment in Thailand: Updated edition: 2019. Nontaburi: 2021.p 108-23.
Chang LR, Lin YH, Chang HC, Chen YZ, Huang WL, Liu CM, et al. Psychopathology, rehospitalization and quality of life among patients with schizophrenia under home care case management in Taiwan. J Formos Med Assoc 2013; 112: 208-15.
Mihanovic M, Petrovic BR, Bogovic A, Ivezic E, Bodor D, Pozgain I. Quality of life of patients with schizophrenia treated in foster home care and in outpatient treatment. Neuropsychiatr Dis Treat 2015; 11: 585-95.
Hafiz AH, Samy MA, Fahmy AM, Ibrahim SA, Mesailhi M. Psychiatric home care, length of hospital stay and risk of rehospitalization in patients suffering from schizophrenia; a case control study in Al Madinah Al Munawarah Region. J T U Med Sc 2010; 5: 49–52.
Thaweethamcharoen T, Noparatayaporn P, Sritippa yawan S, Aiyasanon N. Comparison of EQ-5D-5L, VAS, and SF-6D in Thai patients on peritoneal dialysis. Value Health Reg Issues. 2019;18: 59-64.
Oddershede L, Andreasen JJ, Ehlers L. Estimation of utility values from visual analog scale measures of health in patients undergoing cardiac surgery. ClinicoEcon Outcomes Res 2013; 6: 21-7.
Katanyoo K, Thavorncharoensap M, Chaikledkaew U, Riewpaiboon A. A comparison of six approaches for measuring utility values among patients with locally advanced cervical cancer. Expert Rev Pharmacoecon Outcomes Res. 2021; 1-11. doi: 10.1080/14737167.2021.1906224.
Tzeng D-S, Lian L-C, Chang C-U, Yang C-Y, Lee G-T, Pan F, Lung FW. Healthcare in schizophrenia: effectiveness and progress of a redesigned care network. BMC Health Serv Res. 2007;7: 129.
Fenton WS, Hoch JS, Herrell JM, Mosher L, Dixon L. Cost and cost-effectiveness of hospital vs resi dential crisis care for patients who have serious mental illness. Arch Gen Psychiatry 2002; 59: 357-64.
Anon. Annual Budget B.E.2562: National Health Security Fund [online]. 2019 [cited Oct 28, 2020]. Available from: www.hfocus.org/content/2018/07/1 6088.
National Health Security Office, Region 10, Ubon Ratchathani. Allocation of the number of SMI-V patients for each service unit to join the Community Psychiatric Recovery Fund Project 2019. In: Budget Allocation Meeting for Chronic Psychiatry in District 10th health, fiscal year 2019; 15 January 2019; At the Ubon Ratchathani Provincial Public Health Office. Ubon Ratchathani; 2019. p14-5.
