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Psychiatric advance directives facilitated by peer workers among people with mental illness: economic evaluation of a randomized controlled trial (DAiP study)

AIMS: We aimed to assess the cost-effectiveness of psychiatric advance directives (PAD) facilitated by peer workers (PW-PAD) in the management of patients with mental disorders in France. METHODS: In a prospective multicentre randomized controlled trial, we randomly assigned adults with a Diagnostic...

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Autores principales: Loubière, S., Loundou, A., Auquier, P., Tinland, A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10130836/
https://www.ncbi.nlm.nih.gov/pubmed/37096868
http://dx.doi.org/10.1017/S2045796023000197
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author Loubière, S.
Loundou, A.
Auquier, P.
Tinland, A.
author_facet Loubière, S.
Loundou, A.
Auquier, P.
Tinland, A.
author_sort Loubière, S.
collection PubMed
description AIMS: We aimed to assess the cost-effectiveness of psychiatric advance directives (PAD) facilitated by peer workers (PW-PAD) in the management of patients with mental disorders in France. METHODS: In a prospective multicentre randomized controlled trial, we randomly assigned adults with a Diagnostic and Statistical Manual of Mental Disorders, fifth edition diagnosis of schizophrenia, bipolar I disorder or schizoaffective disorders, who were compulsorily hospitalized in the past 12 months, to either fill out a PAD form and meet a peer worker for facilitation or receive usual care. We assessed differences in societal costs in euros (€) and quality-adjusted life-years (QALYs) over a year-long follow-up to estimate the incremental cost-effectiveness ratio of the PW-PAD strategy. We conducted multiple sensitivity analyses to assess the robustness of our results. RESULTS: Among the 394 randomized participants, 196 were assigned to the PW-PAD group and 198 to the control group. Psychiatric inpatient costs were lower in the PW-PAD group than the control group (relative risk, −0.22; 95% confidence interval, [−0.33 to −0.11]; P < 0.001), and 1-year cumulative savings were obtained for the PW-PAD group (mean difference, −€4,286 [−4,711 to −4,020]). Twelve months after PW-PAD implementation, we observed improved health utilities (difference, 0.040 [0.003–0.077]; P = 0.032). Three deaths occurred. QALYs were higher in the PW-PAD group (difference, 0.045 [0.040–0.046]). In all sensitivity analyses, taking into account sampling uncertainty and unit variable variation, PW-PAD was likely to remain a cost-effective use of resources. CONCLUSION: PW-PAD was strictly dominant, that is, less expensive and more effective compared with usual care for people living with mental illness.
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spelling pubmed-101308362023-04-27 Psychiatric advance directives facilitated by peer workers among people with mental illness: economic evaluation of a randomized controlled trial (DAiP study) Loubière, S. Loundou, A. Auquier, P. Tinland, A. Epidemiol Psychiatr Sci Original Article AIMS: We aimed to assess the cost-effectiveness of psychiatric advance directives (PAD) facilitated by peer workers (PW-PAD) in the management of patients with mental disorders in France. METHODS: In a prospective multicentre randomized controlled trial, we randomly assigned adults with a Diagnostic and Statistical Manual of Mental Disorders, fifth edition diagnosis of schizophrenia, bipolar I disorder or schizoaffective disorders, who were compulsorily hospitalized in the past 12 months, to either fill out a PAD form and meet a peer worker for facilitation or receive usual care. We assessed differences in societal costs in euros (€) and quality-adjusted life-years (QALYs) over a year-long follow-up to estimate the incremental cost-effectiveness ratio of the PW-PAD strategy. We conducted multiple sensitivity analyses to assess the robustness of our results. RESULTS: Among the 394 randomized participants, 196 were assigned to the PW-PAD group and 198 to the control group. Psychiatric inpatient costs were lower in the PW-PAD group than the control group (relative risk, −0.22; 95% confidence interval, [−0.33 to −0.11]; P < 0.001), and 1-year cumulative savings were obtained for the PW-PAD group (mean difference, −€4,286 [−4,711 to −4,020]). Twelve months after PW-PAD implementation, we observed improved health utilities (difference, 0.040 [0.003–0.077]; P = 0.032). Three deaths occurred. QALYs were higher in the PW-PAD group (difference, 0.045 [0.040–0.046]). In all sensitivity analyses, taking into account sampling uncertainty and unit variable variation, PW-PAD was likely to remain a cost-effective use of resources. CONCLUSION: PW-PAD was strictly dominant, that is, less expensive and more effective compared with usual care for people living with mental illness. Cambridge University Press 2023-04-25 /pmc/articles/PMC10130836/ /pubmed/37096868 http://dx.doi.org/10.1017/S2045796023000197 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0 (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
spellingShingle Original Article
Loubière, S.
Loundou, A.
Auquier, P.
Tinland, A.
Psychiatric advance directives facilitated by peer workers among people with mental illness: economic evaluation of a randomized controlled trial (DAiP study)
title Psychiatric advance directives facilitated by peer workers among people with mental illness: economic evaluation of a randomized controlled trial (DAiP study)
title_full Psychiatric advance directives facilitated by peer workers among people with mental illness: economic evaluation of a randomized controlled trial (DAiP study)
title_fullStr Psychiatric advance directives facilitated by peer workers among people with mental illness: economic evaluation of a randomized controlled trial (DAiP study)
title_full_unstemmed Psychiatric advance directives facilitated by peer workers among people with mental illness: economic evaluation of a randomized controlled trial (DAiP study)
title_short Psychiatric advance directives facilitated by peer workers among people with mental illness: economic evaluation of a randomized controlled trial (DAiP study)
title_sort psychiatric advance directives facilitated by peer workers among people with mental illness: economic evaluation of a randomized controlled trial (daip study)
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10130836/
https://www.ncbi.nlm.nih.gov/pubmed/37096868
http://dx.doi.org/10.1017/S2045796023000197
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