COST EFFECTIVENESS OF DUAL DIAGNOSIS TREATMENT

本提案旨在对一项研究进行竞争性更新， 两种方法治疗患有双重疾病的人的成本效益 严重精神疾病和物质使用障碍的诊断。 我们 对比连续治疗团队（CTT），其整合了直接治疗 针对药物滥用和精神疾病的广泛宣传 传统的社区支持计划（CSP），在这种情况下， 管理人员设法将客户与适当的治疗提供者联系起来。 我们 要求提供资金，以完成最初提议的研究， 将随访期从两年延长至三年。 240名客户被随机分配到CTT或CSP 在新的七个社区精神卫生中心（CMHC）， 汉普郡。 监测了两种治疗模式的实施情况 我们的初步数据表明，CTT和CSP方法不同， 在治疗的种类和数量上有很大的不同。 自从我们最初的 在提交意见书后，我们已测试和改进了衡量 与双重诊断相关的社会（社会）成本。 响应于 根据审查委员会的要求，我们还制定了一个方法， 在成本效用分析（CA）中结合多个结果。 的CA 从三个群体的角度考虑治疗的效用： 客户，家庭和治疗提供者。 由于与双重障碍有关的困难，这些客户是 人们普遍认为他们是特别高的资源使用者。 我们假设 CTT客户端使用的总资源将随着时间的推移而减少， 每个患者的时间和资源的初始投资可能更大 与CSP方法相比，CTT将更具成本效益 在三年的随访期内，CSP。 社区和家庭负担等社会成本问题已成为 更重要的是，患有严重精神疾病的人花在 医院和更多的时间在家里或在社区。 既往精神疾病 健康成本研究使用间接方法估算社区和 家庭成本，测量不完全，或使用粗略的估计。 在这 我们改进了现有的记录使用和成本的技术 社区和家庭资源。 我们假设CTT客户将 与CSP客户相比， 随访期。

This proposal is for a competitive renewal of a study that compares the cost-effectiveness of two approaches to treating people who have dual diagnoses of severe mental illness and substance use disorders. We contrast Continuous Treatment Teams (CTT), which integrate direct treatment for substance abuse and psychiatric disorders in an intensive outreach approach, with traditional Community Support Programs (CSP), in which case managers seek to link clients to appropriate treatment providers. We are requesting funding to complete the study as originally proposed and to extend the follow-up period from two to three years. Two hundred forty clients have been randomly assigned to either CTT or CSP at a total of seven Community Mental Health Centers (CMHCs) in New Hampshire. Implementation of the two treatment models has been monitored carefully, and our initial data show that CTT and CSP approaches differ significantly in the types and amounts of treatment. Since our original submission, we have tested and refined our procedures for measuring the social (societal) costs associated with dual diagnoses. In response to the review committee's request, we have also developed an approach for combining multiple outcomes in a cost-utility analysis (CA). The CA considers the utility of treatment from the perspectives of three groups: clients, families, and treatment providers. Because of difficulties associated with dual disorders, these clients are widely believed to be particularly high resource users. We hypothesize that total resource use by CTT clients will decrease over time, even though the initial investment of time and resources per patient may be greater than that of the CSP approach, and that CTT will be more cost-effective than CSP within the three year follow-up period. Questions of social costs such as community and family burden have become more important as people with severe mental illness spend less time in hospitals and more time at home or in the community. Previous mental health cost studies used indirect methods for estimating community and family costs, measured them incompletely, or used crude estimates. In this study we have improved on existing techniques for documenting use and costs of community and family resources. We hypothesize that CTT clients will use fewer family and community resources than CSP clients during the follow-up period.