An economic evaluation of inpatient treatment versus day hospital care for psychiatric patients

Objectives: To provide a methodology for the examination of costs and clinical outcomes in two distinct care settings for psychiatric patients - inpatient and day hospitals. The major emphasis is on the relationship between costs and outcomes in the two care regimes.Method: The study is a retrospective cost-effectiveness analysis. People living in Sector B catchment area in the Mid-Western Health Board who were admitted to inpatient care, or treated as day hospital patients, between June 1st 1994 February 28th 1995 are eligible for inclusion in the study. Information on resource use and clinical outcome is available for 92 of these patients.Results: The average weekly cost of care for mentally ill patients in the inpatient setting is over twice the level of the cost of care for people attending the day hospital facility. Pay costs and hotel costs are higher in the inpatient facility. Day hospital care is also more cost-effective than inpatient care, when account is taken of the relationship between cost and clinical outcomes.Conclusion: The study supports the general literature view of the superiority of community care settings for certain categories of mentally ill people. However, the absence of randomisation in the study, incomplete data, and the retrospective nature of the analysis suggests that caution is needed in the interpretation of the results.