Abstract
The cost-effectiveness of intensive case management (ICM), compared with standard psychiatric services, was evaluated. Referrals to ICM were randomly allocated to either ICM (n=39), or existing services (n=38). Use of all publicly financed services was collected, from study entry for 18 months. Services used were costed and the two groups compared. In comparison with standard psychiatric services, ICM clients received more psychiatric out-patient, primary health, residential and social services care, in addition to high levels of input from case managers. The ICM group therefore cost nearly three times as much as the control group. ICM teams may be necessary to keep contact with some clients, but achieve very limited clinical or social outcome, at high cost. The cost could be reduced by either adjusting team skill mix, varying intensity of contact with clients or by a corresponding reduction in the use of in-patient care.
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