Increasing Cost-effectiveness of Inpatient Treatment of Affective Disorders

Not Applicable

Completed

• Conditions: Depressive Disorder
• Interventions: Other: Symptom based discharge management; Other: Treatment as usual

• Registration Number: NCT00662428
• Lead Sponsor: University Hospital Freiburg

Brief 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.

Study Timeline

• Study First Submitted: 2008-04-15
• Study First Submitted QC: 2008-04-15
• Study First Posted: 2008-04-21
• Study Start: 2008-05
• Primary Completion: 2010-09
• Study Completion: 2011-08
• Status Verified: 2012-06
• Last Update Submitted: 2012-06-20
• Last Update Posted: 2012-06-21

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 202

Inclusion Criteria

• Current depressive episode at time of admission

• ICD-10 diagnosis:

  • Depressive episode, F 32.xx
  • Recurrent depressive episode, F 33.xx

• Depression is primary treatment indication

• The ability to give informed consent

• Sufficient German language skills

• Being resident sufficiently close to the hospital for being able to take part in the outpatient program

• permanent residence

Exclusion Criteria

• Dementia
• Alcohol or drug dependence (not misuse)
• Psychotic symptoms
• Schizoaffective disorders
• Bipolar disorders
• Schizophrenia

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Intervention	Symptom based discharge management	-
Control	Treatment as usual	-

Primary Outcome Measures

Name	Time	Method
Cost-effectiveness: ratio of treatment response and treatment costs	one year after discharge

Secondary Outcome Measures

Name	Time	Method
patient satisfaction	at discharge
Symptom reduction	at discharge, 6 month after discharge, and one year after discharge

Trial Locations

Locations (5)

Krankenhaus Hofheim; 🇩🇪 Hofheim, Hessen, Germany

Bezirkskrankenhaus Bayreuth; 🇩🇪 Bayreuth, Germany

Freiburg University Medical Center, Dept. of Psychiatry and Psychotherapy; 🇩🇪 Freiburg, Germany

Klinikum am Weissenhof; 🇩🇪 Weinsberg, Germany

Städtisches Klinikum Karlsruhe; 🇩🇪 Karlsruhe, Germany