Cost-utility analysis of home treatment versus inpatient treatment in child and adolescent psychiatry: a decision analysis.

Introduction: Health-economic evidence comparing home treatment (HT) and inpatient treatment (IT) in child and adolescent psychiatry is scarce. This study assessed the cost-effectiveness of both interventions for children and adolescents in acute psychiatric crises using a decision analysis. Methods: We developed a Markov state-transition model to evaluate the cost-effectiveness of HT compared to IT in children and adolescents with an acute psychiatric crisis, over a 3-year time horizon from a German healthcare provider perspective. Evaluated outcomes included quality-adjusted life years (QALYs) gained, total costs, and the incremental cost-utility ratio (ICUR; in Euro per QALY). Transition probabilities and utility values were obtained from the published literature. Direct medical and direct non-medical costs for IT were derived from German reference data published by the Institute for the Hospital Remuneration System (InEK). Costs for HT were estimated using micro-costing based on the German ward-equivalent treatment model (Stationsäquivalente Behandlung, StäB). Costs and effects were discounted at 3% annually. One-way and probabilistic sensitivity analyses assessed the robustness of the base-case analysis results. Results were reported in accordance with the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist. Results: HT was associated with lower discounted costs (61,213 €) and slightly fewer discounted QALYs (1.801 QALYs) compared to IT (total costs: 93,737 € and 1.807 QALYs). Moving from HT to IT was associated with 0.006 QALYs gained and resulted in an ICUR of 5,417,376 €/QALY gained. Results were robust in sensitivity analyses over a wide range of parameter variation. Discussion: This cost-utility analysis suggests that HT may be a cost-effective alternative to IT in children and adolescents with acute psychiatric crises in Germany, primarily driven by substantial cost savings during the acute phase. However, due to limited and heterogeneous clinical data, results should be interpreted cautiously. Future randomized studies with longer follow-up and child and disease-specific quality-of-life measures are needed to validate these findings.