PMH23: DEINSTITUTIONALIZATION OF SCHIZOPHRENIC PATIENTS: COST-CONSEQUENCES AND POLICY IMPLICATION OF INTENSIVE CASE MANAGEMENT VERSUS STANDARD CASE MANAGEMENT

Abstract

OBJECTIVES: In France a large part of acute hospitalisation beds are occupied by long-term hospitalisation of schizophrenic patients. A model was developed to compare Intensive Case Management (ICM) to Standard Case Management (SCM) for long-term hospitalised chronic schizophrenic patients. METHODS: A model was used to evaluate the number of patients that are either successfully dechronized, experiencing failure, or are readmitted to hospital within a year for a cohort of 100 chronic schizophrenic patients. With these figures, it was possible to estimate the needs in terms of number of beds and employees in the catchment area of Clermont-Ferrand in France, for the 1st, 2nd and 3rd year after the ICM strategy have been implemented. RESULTS: At the beginning of the first year, 100 hospitalisation beds, 30 nurses, 10 psychologists and 5 psychiatrists were needed. After 1 year these numbers were respectively reduced to 50, 15, 10 and 2.5 due to the success of the ICM strategy. This positive trend is also recorded for the second year of implementation. At the end of the 3rd year a steady point level is nevertheless reached with the model, due to the fact that there will always be patients that can not be dechronized; the numbers at this point will be 11 beds, 3 nurses, 1 psychologist and a half-time psychiatrist. CONCLUSIONS: Due to the important caseload of ICM, it remains more costly than SCM at implementation, but will reduce cost from year 1, and be less costly than SCM from year 3. This model can therefore evaluate the economic impact of creating a dechronization unit in a catchment area and make budgetary prevision for large-scale implementation of ICM in France.