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BACKGROUND: Intensive case management is commonly advocated for the care of the severely mentally ill, but evidence of its cost-effectiveness is lacking. AIMS: To investigate the cost-effectiveness of intensive compared with standard case management for patients with severe psychosis. METHOD: 708 patients with psychosis and a history of repeated hospital admissions were randomly allocated to standard (case-loads 30-35) or intensive (case-loads 10-15) case management. Clinical and resource use data were assessed over two years. RESULTS: No statistically significant difference was found between intensive and standard case management in the total two-year costs of care per patient (means 24,550 Pounds and 22,700 Pounds, respectively, difference 1850 Pounds, 95% CI--1600 Pounds to 5300 Pounds). There was no evidence of differential effects in African-Caribbean patients or in the most disabled. Psychiatric in-patient hospital stay accounted for 47% of the total costs, but neither such hospitalisation nor other clinical outcomes differed between the randomised groups. CONCLUSION: Reduced case-loads have no clear beneficial effect on costs, clinical outcome or cost-effectiveness. The policy of advocating intensive case management for patients with severe psychosis is not supported by these results.


Journal article


Br J Psychiatry

Publication Date





537 - 543


Adolescent, Adult, Aged, Cost-Benefit Analysis, Critical Care, Follow-Up Studies, Hospitalization, Humans, Middle Aged, Psychotic Disorders, Treatment Outcome, West Indies