Increasing Cost-effectiveness of Inpatient Treatment of Affective Disorders
Condition: Depressive Disorder
MeSH terms: Depressive Disorder
Study type: Interventional

Summary: 
      The cost-effectiveness of a new, guideline oriented sequential inpatient - outpatient
      treatment model will be investigated. Secondary outcomes are: patient satisfaction,
      practitioners' satisfaction and influence on work.
    

Detailed description: 
      Great diversity concerning duration of inpatient treatment of depression in
      psychiatric-psychotherapeutic hospitals is often used as an argument for the possible
      reduction of length of stay. Yet shorter duration of inpatient treatment of depressive
      episodes has not been examined systematically concerning clinical outcomes and health
      economic consequences. In this study the cost-effectiveness of a new sequential
      inpatient-outpatient treatment model will be examined. The research hypothesis is that the
      new treatment model will be more cost-effective than treatment as usual. The design provides
      a randomized controlled trial (RCT) in four psychiatric-psychotherapeutic clinics with a
      total of 240 patients. First medical practitioners and psychologist will receive a retraining
      concerning guideline-based care and the new treatment model will be implemented in the
      hospitals. New patients admitted to one of the hospitals will then be assigned randomly to
      one of the two study conditions und prospectively examined at five measuring times: Condition
      A (control group) contains treatment as usual (individual treatment programme, discharge
      after remission), Condition B (intervention group) contains the sequential
      inpatient-outpatient treatment (guideline-based treatment, discharge after partly remission:
      BDI <20, outpatient treatment in the hospital and guided transfer to outpatient care).

      Primary outcome is the reduction of costs of treatment in relation to reduction of symptoms.
      Secondary outcomes will be reduction of the depressive pathology as well as the extent of
      satisfaction among patients and practitioners. A total of 240 patients will be examined from
      admission until 12 month after discharge. Both information from the patients and the
      practitioners will be charged with well implemented and established instruments (psychiatric
      basic documentation system, BADO). A specific questionnaire will be used to measure the
      practitioners' satisfaction and the consequences of the sequential inpatient-outpatient
      treatment. To answer the main question about the cost-effectiveness analyses of central
      health economic outcome variables (direct and indirect costs of treatment) will be performed.
      This study is going to give differentiated and scientific evidence of the efficiency of a new
      sequential inpatient-outpatient treatment for depressive disorders. The participation of
      psychiatric-psychotherapeutic hospitals with different functions and structures in the public
      health care systems (academic medical centre, psychiatric department of general hospital,
      psychiatric centres) enable the evaluation of the new treatment model under diverse
      structural and organizational conditions.
    

Intervention name(s): Symptom based discharge management; Treatment as usual
Intervention type(s): Other; Other
Intervention description(s): Depressive symptoms of patients are weekly assessed by Beck Depression Inventory (BDI II). Patients are discharged when BDI-score is under 20 points. Patients are treated in the same hospital for two more weeks as outpatients before being referred to outpatient care (general practitioner or specialist).; Treatment as usual is the usual stationary depression treatment which consists of a combination of several psychopharmacological and psychotherapeutical treatments. Duration of treatment is varying widely.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: cost-benefit analysis; practice guideline; inpatients