The current study used the comprehensive costing methodology of Knapp and Beecham (1990) to examine the comprehensive costs of community support services over the last six months (18--24 months) of a two-year study. The sample consisted of 77 clients with severe and persistent mental illness and a history of homelessness receiving either intensive case management (ICM) or standard care. Costs from the overall societal perspective were calculated by summing the direct and 'hidden' (e.g., travel time) costs associated with: (1) Agency costs (case management services), (2) governmental costs (e.g., non-agency health care costs, non-health care costs), and (3) family/friend costs. Subtracted from this initial total to reach a final societal cost were employment and/or volunteer 'benefits'. Of interest in the study was: (1) Examining the relationship between clients needs at 18 months of a two year trial, global societal costs per client for the six-month period from 18 to 24 months, and 24-month outcomes, and (2) cost-effectiveness of intensive case management over standard care from three costing perspectives (e.g., agency, government, society). Results yielded an overall average comprehensive cost of treatment (both ICM and standard care combined) per client of $57.08/day which is comparable to previous research investigating the costs of community support services. Needs did not predict six month total societal costs; however, receiving ICM and reporting more severe symptomatology predicted higher six-month agency costs. Higher total costs of services and supports predicted poorer housing stability at 24 months for our participants. Higher expenditures related to non-health care costs predicted poorer community ability at 24 months. In general, it seems that higher costs are related to poorer client functioning. Cost-effectiveness analyses revealed that ICM is more cost-effective than standard care from the perspective of the government (i.e., health-related expenses) and society overall, despite agency costs being significantly greater in ICM. Nonparametric bootstrapping methods using net monetary benefit revealed a 0.77 to 0.80 chance of ICM being a cost-effective alternative to standard care. It is clear from this study that increased costs are associated with clients who are doing the poorest in terms of symptoms, housing stability, and community ability. Despite the finding that more intensive treatment does not guarantee better clinical outcomes within our six month window, ICM is shown to be a more cost-effective treatment in the community when compared with standard care. Implications of this research are discussed.
| Identifer | oai:union.ndltd.org:uottawa.ca/oai:ruor.uottawa.ca:10393/29756 |
| Date | January 2009 |
| Creators | Birnie, Sarah |
| Publisher | University of Ottawa (Canada) |
| Source Sets | Université d’Ottawa |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | 266 p. |
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