Andrew J. Fenyo

A comparison of the cost-effectiveness of sertraline versus tricyclic antidepressants in primary care

There has been considerable debate concerning the cost-effectiveness of selective serotonin re-uptake inhibitors (SSRIs) versus tricyclic antidepressants (TCAs) thus far using crude prescription price comparisons or reductionist decision-analytic models. This paper employs a retrospective quasi-experimental design where data on service utilisation, use of medication and informal care were collected for two groups of patients in general practice settings. The mean cost of treatment was marginally greater for those people receiving TCA medication due to greater use of psychiatric services. Factors such as age, previous depression and concomitant physical illness are all associated with greater treatment costs. Further analysis using a prospective design is recommended.

The costs of community-based psychiatric care for first-ever patients: a case register study

BACKGROUND Analysing costs measures in conjunction with psychiatric case register (PCR) data can provide important epidemiologically-based information on resource utilization. Costing the service use patterns of first-ever patients can indicate the shape and likely resource consequences for mental health services operating within a community-based system of care. METHODS Yearly costs were calculated for the 299 first-ever patients and 768 longer-term patients who contacted the South-Verona Psychiatric Case Register between 1 January 1992 and 31 December 1993. Bivariate and multivariate analyses were used to compare costs between these groups and to test the associations between costs and the sociodemographic and diagnostic data recorded on the PCR. RESULTS For all diagnostic groups identified, first-ever patients were found to be less costly to support than longer-term patients, even after adjustment for various factors, including whether patients were single consulters. When multivariate analyses were employed, between 20% and 69% of the cost variation for first-ever patients could be explained by patient and other characteristics, and the effect of the contact (first or subsequent) variable was reduced. CONCLUSION This study considered only the costs to the specialist psychiatric services but the methodology allows the likely annual resource implications of supporting new patients to be predicted from data collected at first contact. Such information can help ensure that services are adequately funded and that the resources are deployed appropriately between client groups.

The costs of accommodation and care: Community provision for former long-stay psychiatric hospital patients

SummaryThe development of community services to replace two long-stay psychiatric hospitals in the North East Thames Health Authority region of the UK has been the subject of a research programme since 1985. The economic evaluation is conducted by the Personal Social Services Research Unit; research results relating to the first five cohorts of hospital leavers are reported in this paper. When followed up 1 year after discharge, almost half of the sample were living in highly supported residential care units, most of which were managed by district health authorities. More than 40 services provided outside the accommodation facility were used by clients and, although contact with certain professionals remained constant, some changes in service use over time were marked. The average total cost of community care for this group was £ 493 per week (1992–93 prices), accommodation facility costs comprising approximately 85% of the total. In the new service configuration, district health authorities fund half of the costs of supporting the hospital leavers, 50% less than when they funded long-stay hospital placements. The rest of the funding burden is borne by a range of agencies, resulting in pressure on budgets and staff case loads.

Foster Care Breakdown: A Study of a Special Teenager Fostering Scheme

The overwhelming majority of children boarded out with foster parents are still at the younger end of the age range, but many public and voluntary agencies have established special placement projects to find families for adolescents, teenagers or other traditional “hard to place” groups. Anxiety of placements which “fail” is no less prevalent among this older group as the effects of disruption are perhaps more strongly felt. This paper is an empirical investigation into the factors which cause placements to fail in one such special fostering scheme: the Kent Family Placement Scheme (KFPS). Using routine monitoring procedures we explore the factors which are associated with, and predictive of, placement breakdown. A further aim has been to comment on the research methodology commonly used in previous breakdown research, which has rarely taken full advantage of the data collected. A description of the KFPS and a brief discussion of alternate measures of outcomes and definitions of breakdown are followed by an exposition of logit analysis — the methodology employed in this study. The results of these analyses — in which we successfully predict 79 per cent of placement outcomes — are reported under three heads: teenager characteristics, foster placement characteristics and child care practices. Implications for care practice are highlighted.

Efficiency in Foster Family Care: Proceeding With Caution

Foster family care has long been preferred to residential care for the majority of children unable to live with their parents, and in Britain this preference — couched overwhelmingly in “welfare” terms — permeates both public and voluntary (non-profit) agencies. This paper is not directly concerned with these “welfare” arguments, but focuses instead on the encouragement given to these arguments by claims that foster family care is a cheap alternative to residential. The paper confirms the oft-posited relative cost or “value for money” difference, but suggests that the potential cost savings to be reaped from expanding the fostering proportion have been exaggerated. We concentrate mainly on the cost side of the efficiency concept but do not take the view that cost considerations should necessarily have pre-eminence over outcome and other considerations. However we believe it is better for child care research to seek to work with cost information rather than ignoring it or reacting against it. Our evidence — still far from perfect — implies that the commonly employed cost argument for the expansion of the foster care proportion seriously under-estimates the future costs of foster care and dangerously exaggerates the savings. If the funding base for social care services is as fragile as some public authorities in Britain maintain, these real future costs could have unfortunate implications for the development of this service and for its effectiveness.