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The REACT Study: Cost-Effectiveness Analysis of Assertive Community Treatment in North London

Dr. McCrone is affiliated with the Health Services and Population Research Department, King's College London, PO24 Institute of Psychiatry, De Crespigny Park, London SE5 8AF United Kingdom (e-mail: paul.mccrone{at}kcl.ac.uk). All other authors are with University College London.

OBJECTIVE: Assertive community treatment (ACT) is a key component of mental health care, but recent information on its cost-effectiveness is limited. This article provides a cost-effectiveness analysis of assertive community treatment and usual care from community mental health teams (CMHTs) in the United Kingdom. METHODS: Participants who had difficulties engaging with community services were randomly assigned to ACT (N=127) or continued usual care from CMHTs (N= 124). Costs were measured at baseline and 18 months later and compared between the two groups. In the analysis, cost data were linked to information on satisfaction, which had been shown to be significantly higher with ACT. RESULTS: Total follow-up costs over 18 months were higher for the ACT group by £4,031 ($6,369), but this was not statistically significant (95% confidence interval of -£2,592 to £10,690 [-$4,095 to $16,890]). A one-unit improvement in satisfaction was associated with extra costs in the ACT group of £473 ($747). CONCLUSIONS: The costs of ACT were not significantly different from usual care. ACT did, however, result in greater levels of client satisfaction and engagement with services and as such may be the preferred community treatment option for patients with long-term serious mental health problems.

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