Cost Utility Analysis On Different Rehabilitation Patterns For Psychiatric Disability

[Objective] Cost Utility Analysis on Different Rehabilitation Patterns for Psychiatric Disability[Method]Use prospective intervention study method for patients with mental disabilities in three different modes of conduct rehabilitation in a district of Shanghai, make an investigation of the costs into the group before and after, and evaluate the effectiveness and utility.2.1 The key output indicators:key indicators in this study the cost per unit of output, effects, and the incremental cost-effectiveness indicators.2.1 Study subjects:extracting a district in Shanghai registered management of patients with mental disabilities to participate in voluntary inpatient rehabilitation, community rehabilitation mode and day rehabilitation model is about 30 cases.Inclusion criteria:compliance with psychiatric disability standards; aged 20 to 65 years, equal to a mental illness in the course of a large, acute phase discharge criteria have been met, with complete insight, to exclude patients with other physical disabilities. Informed consent of the patient and guardian consent, and signed informed consent.Balancing test the three groups in gender, age, occupation, family economic conditions, social functioning, mental status, etc,before into groups. 2.2 Assessment Method:Divided into groups before and follow-up evaluation:the investigators by a unified training and consistency test to investigate, about general information> the health survey (SF-36) and overall mental health index scale (PGWB) tools to measure the utility value QALY to assess psychiatric symptoms, social functioning, quality of life and other related uses questionnaires, assessed by a self-assessment questionnaire, and his assessment questionnaire.[Results]1.General data comparisonThrough questionnaire to assessment of the different modes of rehabilitation patients in one year, complete follow-up and a total of 82 cases, including 22 cases inpatient rehabilitation, day rehabilitation group of 27 cases,33 cases of community-based rehabilitation group the more general information, age, age, marital and family status, age difference (which inpatient rehabilitation model’s age was significantly higher than during the day and rehabilitation and community rehabilitation mode) (p<0.001), there was no significant difference among other basic conditions, mental illness distribution of the different modes, the status of the disease did not significantly different, medication did not significantly different for social support before patients using different modes into two groups, subjective support and objective support and support utilization on no significant differences. These results show that the three groups of patients substantially flush with general information, comparability relatively strong.2 The effect of the different recovery pattern comparisonThe inpatient rehabilitation group’s employment rate was 7%, the recurrence rate was 57%, social participation was 20%, significantly better rate of 66%, while the cost of 4946.95 yuan/month, followed by day rehabilitation group employment rate was 14%, the recurrence rate was 43%, social participation rate was 47%, significantly better rate of 69%, while the cost of 2005.24 yuan/month, community-based rehabilitation group employment rate was13%, the recurrence rate was 38%,68% social participation, which was a good rate of 66%, while the cost is only 665.36 yuan /month.3. The different rehabilitation model of cost-utilityBurden of disease in patients to compare different rehabilitation model, the burden of disease in patients with different patterns of recovery were significantly different (p≤ 0.01), and the burden on the patient’s inpatient rehabilitation mode heaviest (4946.95 yuan/month), followed by day rehabilitation (2005.24 yuan/month), community-based rehabilitation lowest (665.36 yuan/month). Different recovery mode for the SF-36 or PGWB utility index into the group before the three groups were close to the utility, the difference was not statistically significant (p> 0.05), the effectiveness of community-based rehabilitation group at follow-up the highest value, followed by day rehabilitation group, inpatient rehabilitation lowest group, and among the three groups was statistically significant (p difference< 0.05), but the utility value of acquired no significant difference (p between the three groups> 0.05). From the incremental cost-effectiveness value (ICUA) judgment to SF36 for the utility index and the group as inpatient rehabilitation, community rehabilitation group each get an extra QA1Y to consume 2,589,545 yuan, day rehabilitation group will have to consume more than 646,900 yuan. In PGWB indicators and inpatient rehabilitation for the utility as a control group, each group of community-based rehabilitation to get an extra QA1Y to consume 4,524,231 yuan, day rehabilitation group will have to consume more than 385,432 yuan. Be seen as a reference to inpatient rehabilitation, day rehabilitation group is much higher than the additional cost of community-based rehabilitation group, from the incremental cost-utility analysis of the results, the most cost-effective community-based rehabilitation group.[Conclusions]Compare with effect,the community rehabilitation model is the best model, Through cost-utility analysis, access to the highest quality of life of community rehabilitation model, but also the least cost, community-based rehabilitation model is relatively mature, economical and reliable recovery mode. Currently mental disability rehabilitation carried out in several different modes, the functions have their own characteristics and advantages, but some features due to different emphases in different organizational structure, functions of various rehabilitation models need to be further improved.Government can continue to vigorously pursue community rehabilitation mental disability, mental disability at home so that you can enjoy professional services, while significantly reducing the direct and indirect costs for patients. Meanwhile the government’s strategy to adjust mental disability rehabilitation, integration of resources of various departments, will combine the advantages of various rehabilitation models onwards, take advantage of a variety of rehabilitation model, the maximum provision of quality mental health service resources to more mental illness patients.