Increasing Cost-effectiveness of Inpatient Treatment of Affective Disorders (INCA)
|Depressive Disorder||Other: Symptom based discharge management Other: Treatment as usual|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Health Services Research
|Official Title:||Evaluation of a Guideline-based Net Care Intervention to Reduce the Duration of Inpatient Depression Treatment|
- Cost-effectiveness: ratio of treatment response and treatment costs [ Time Frame: one year after discharge ]
- Symptom reduction [ Time Frame: at discharge, 6 month after discharge, and one year after discharge ]
- patient satisfaction [ Time Frame: at discharge ]
|Study Start Date:||May 2008|
|Study Completion Date:||August 2011|
|Primary Completion Date:||September 2010 (Final data collection date for primary outcome measure)|
Other: Symptom based discharge management
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).
|Active Comparator: Control||
Other: Treatment as usual
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.
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.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00662428
|Hofheim, Hessen, Germany, 65719|
|Bayreuth, Germany, D-95445|
|Freiburg University Medical Center, Dept. of Psychiatry and Psychotherapy|
|Freiburg, Germany, D-79104|
|Städtisches Klinikum Karlsruhe|
|Karlsruhe, Germany, D-76133|
|Klinikum am Weissenhof|
|Weinsberg, Germany, D-74189|
|Principal Investigator:||Martin Härter, Prof. Dr. Dr.||Freiburg University Medical Center, Dept. of Psychiatry and Psychotherapy|
|Principal Investigator:||Isaac Bermejo, Dr.||Freiburg University Medical Center, Dept. of Psychiatry and Psychotherapy|
|Study Chair:||Lars P Hölzel, Dr.||Freiburg University Medical Center, Dept. of Psychiatry and Psychotherapy|