An economic rationale for mental health care reform in 1 the Czech Republic: cost-effectiveness of care for people 2 with psychosis in the community and psychiatric hospitals 3

Background The absence of economic evidence hinders current reforms of hospital based 32 mental health systems in Central and Eastern Europe. We aimed to assess the cost- 33 effectiveness of care for people with chronic psychoses in psychiatric hospitals compared to 34 discharging patients to the community in the Czech Republic. 35 Methods We conducted a prospective study of people with chronic psychotic disorders and 36 evaluated the impact associated with discharge into community services as compared to not 37 discharging people from psychiatric hospitals at baseline in the Czech Republic. We 38 measured utilization of services, health related quality of life, met and unmet needs, and 39 global functioning using an adapted Client Services Receipt Inventory (CSRI), EQ-5D-5L , 40 Camberwell Assessment of Need (CAN) and General Assessment of Functioning (GAF). 41 Adjusting for baseline differences between the two groups, we assessed differences in 42 societal costs in Euros ( € ) and QALYs over a year-long follow-up which we then used to 43 estimate the incremental cost-effectiveness ratio (ICER). We conducted multiple sensitivity 44 analyses to assess the robustness of our results. Outcomes In our base case we two groups were very similar terms 95% 49 care reforms in Central and Eastern Europe.

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