ArticleThe European journal of health economics : HEPAC : health economics in prevention and care2026
Cost-effectiveness of community versus hospital-based mental healthcare for severe mental illness in South-East Europe: economic evaluation of five randomised trials.
Article in The European journal of health economics : HEPAC : health economics in prevention and care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 5 registered trials, which are not on this map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Large-scale Implementation of Community-based Mental Health Care for People With Severe and Enduring Mental Ill Health in Europe
Large-scale Implementation of Community-based Mental Health Care for People With Severe and Enduring Mental Ill Health in Europe
Large Scale Implementation of Community Based Mental Health Care for People With Severe and Enduring Mental Ill Health in Europe
Large-scale Implementation of Community-based Mental Health Care for People With Severe and Enduring Mental III Health in Europe
Large Scale Implementation of Community Based Mental Health Care for People With Severe and Enduring Mental Ill Health in Europe
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Authors and funding
12 authors.
Funding
Abstract
introductionThe RECOVER-E project supported the shift away from mental health care provided in institutional settings (treatment as usual, TAU) towards community-based mental healthcare by introducing multidisciplinary community mental health teams (CMHT) for people with schizophrenia, bipolar disorder, and severe depression across five sites in Bulgaria, Croatia, Montenegro, North Macedonia, and Romania. This paper presents the cost-effectiveness of CMHT compared to TAU.
methodsData from all five RECOVER-E trials (N = 931) was used to compute healthcare costs and societal costs which included additional patient and family costs, and costs stemming from productivity losses. Outcomes were incremental cost-effectiveness ratio's (ICER) for gaining a QALY and gaining a treatment responder (based on WHODAS 2.0).
resultsCompared to TAU, CMHT had small incremental effects favouring CMHT (QALY: M = 0·023, SD = 0·013; Response: M = 0·093, SD = 0·034). The incremental costs were higher in CMHT than in TAU as seen from both the societal and healthcare perspective (societal costs: M=€1,892, SD=€950; healthcare costs: M = 1,125, SD=€720). The ICER for gaining a QALY was €82,261 and €48,913 as seen from the societal and healthcare perspective, respectively. These ICERs were well above the willingness to pay threshold of €20,000 for gaining a QALY. A similar picture arose with treatment response as outcome.
conclusionOverall CMHT appeared to be more effective but also more costly, with the additional cost outweighing the benefits across countries, except in Bulgaria, which may highlight that cost-effectiveness is likely to be context dependent. Therefore, a recommendation for scaling up or sustaining CMHT must also depend on arguments other than health-economic alone, such as medical ethical, equity and human rights considerations.
trial registrationBulgaria: NCT03922425, Croatia: NCT03862209, Macedonia: NCT03892473, Montenegro: NCT03837340, Romania NCT03884933.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.