Joint crisis plans for people with psychosis: economic evaluation of a randomised controlled trial

doi:10.1136/bmj.38929.653704.55

BMJ 2006;333:729 (7 October), doi:10.1136/bmj.38929.653704.55 (published 16 August 2006)

Research

Joint crisis plans for people with psychosis: economic evaluation of a randomised controlled trial

Chris Flood, lecturer in mental health¹, Sarah Byford, senior lecturer in health economics², Claire Henderson, MRC training fellow in health services research³, Morven Leese, medical statistician⁴, Graham Thornicroft, professor of community psychiatry⁴, Kim Sutherby, consultant psychiatrist⁵, George Szmukler, dean⁶

¹ Department of Mental Health and Learning Disability, City University, London E1 2EA, ² Centre for the Economics of Mental Health, Institute of Psychiatry, King's College, London SE5 8AF, ³ Section of Community Psychiatry, Health Service Research Department, Institute of Psychiatry, King's College, London SE5 8AF, ⁴ Health Service Research Department, Institute of Psychiatry, King's College, London SE5 8AF, ⁵ South London and Maudsley NHS Trust, Croydon CR0 1XT, ⁶ Institute of Psychiatry, King's College, London

Correspondence to: S Byford s.byford{at}iop.kcl.ac.uk

Abstract

Objective To investigate the cost effectiveness of joint crisisplans, a form of advance agreement for people with severe mentalillness.

Design Single blind randomised controlled trial.

Setting Eight community mental health teams in southern England.

Participants 160 people with a diagnosis of psychotic illnessor non-psychotic bipolar disorder who had been admitted to hospitalat least once within the previous two years.

Intervention Joint crisis plan formulated by the patient, carecoordinator, psychiatrist, and project worker containing contactinformation, details of illnesses, treatments, relapse indicators,and advance statements of preferences for care for future relapses.Control group was standardised service information.

Main outcome measures Admission to hospital; service use over15 months.

Results Use of a joint crisis plan was associated with lessservice use and lower costs on average than in the standardisedservice information group, but differences were not significant.Total costs during follow-up were £7264 ( ${euro}$ 10 616, $13 560)for each participant with a joint crisis plan and £8359( ${euro}$ 12 217, $15 609) for each participant with standardised serviceinformation (mean difference £1095; 95% confidence interval-2814 to 5004). Cost effectiveness acceptability curves, usedto explore uncertainty in estimates of costs and effects, suggestthere is a greater than 78% probability that joint crisis plansare more cost effective than standardised service informationin reducing the proportion of patients admitted to hospital.

Conclusion Joint crisis plans produced a non-significant decreasein admissions and total costs. Though the cost estimates hadwide confidence intervals, the associated uncertainty suggeststhere is a relatively high probability of the plans being morecost effective than standardised service information for peoplewith psychotic disorders.

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Rapid Responses:

Read all Rapid Responses

Authors ignore some important variables: AK Al-Sheikhli
bmj.com, 16 Sep 2006 [Full text]
Care Programme Approach?: G sathyendra
bmj.com, 9 Oct 2006 [Full text]
Hospital admission is not failure!: Katharine Nolan
bmj.com, 10 Oct 2006 [Full text]
Overemphasising non significant results: Tom R Dening
bmj.com, 11 Oct 2006 [Full text]
Eligibility criteria require clarification: Ruth V Reed, et al.
bmj.com, 11 Oct 2006 [Full text]
Joint Crisis Plan- A Must: Mohammed Usman
bmj.com, 11 Oct 2006 [Full text]
Authors' reply: Chris M Flood, et al.
bmj.com, 12 Jan 2007 [Full text]
Joint Crisis Plan Template: M Foyle
bmj.com, 18 Mar 2009 [Full text]