COST-EFFECTIVENESS STUDIES IN THE TREATMENT OF SCHIZOPHRENIA - A REVIEW (REPRINTED FROM SOCIAL PSYCHIATRY AND PSYCHIATRIC EPIDEMIOLOGY)

Several carefully conducted cost studies have indicated that care in the community is generally cheaper than care in a hospital, although none of these studies indicate that it is better. As large mental hospitals empty, they are left with a residue of patients who are difficult to discharge, and the marginal cost of discharges increases. "Hostel wards" may offer a humane alternative to long-term hospitalization for those patients with severe disabilities. In the case of acute psychosis, three random controlled trials have indicated that care in the community is more cost effective than hospital care, but there were important exclusions from each trial. Evidence is presented that the more expensive treatment may sometimes be cheaper for society. However, this is not a general rule-some methods of providing day care are more expensive and less effective. Two studies have shown advantages in the treatment of acute psychosis with brief hospitalization followed by day care.