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Background: The Daily Living Programme (DLP) offered intensive home- based care with problem-centred case management for seriously mentally ill people facing crisis admission to the Maudsley Hospital, London. The cost- effectiveness of the DLP was examined over four years. Method: A randomised controlled study examined cost-effectiveness of DLP versus standard in/out- patient hospital care over 20 months, followed by a randomised controlled withdrawal of half the DLP patients into standard care. Three patient groups were compared over 45 months: DLP throughout the period, DLP for 20 months followed by standard care, and standard care throughout. Bivariate and multivariate analyses were conducted (the latter to standardise for possible inter-sample differences stemming from sample attrition and to explore sources of within-sample variation). Results: The DLP was more cost-effective than control care over months 1-20, and also over the full 45-month period, but the difference between groups may have disappeared by the end of month 45. Conclusions: The reduction of the cost-effectiveness advantage for home- based care was perhaps partly due to the attenuation of DLP care, although sample attrition left some comparisons under-powered.

Original publication




Journal article


British Journal of Psychiatry

Publication Date





506 - 512