The impact of Open Dialogue on health care costs: A nationwide register-based cohort study among young Danes in acute psychiatric crises

BACKGROUND: Open Dialogue has been linked to better outcomes and reduced hospital admissions amongst patients with mental health problems. Yet, information on associated health care costs is scarce.

OBJECTIVE: To conduct an evaluation of downstream health care costs of Open Dialogue provided to young patients in acute psychiatric crises and compared with treatment as usual.

DESIGN: Matched case-cohort study based on clinical and register data.

SETTING: Open Dialogue was offered between 2000 and 2019 as standard care to adolescents in acute psychiatric crisis in four municipalities in Region Southern Denmark.

PARTICIPANTS: 355 individuals between 14 and 19 years received treatment with Open Dialogue and were compared to 979 peers who had received standard acute psychiatric treatment in two other Danish Regions (Central Denmark Region and North Denmark Region) where Open Dialogue was not implemented.

METHODS: Health care cost data (including primary care, psychiatric and somatic care) was available during 2005-2018. We matched controls to the cases based on a X-factor propensity score and a 3:1 ratio. The statistical analysis took a double-robust approach combining matching with Difference-in-Difference analysis over 12-year follow-up. Graphical inspection and placebo tests were used to test parallel trends assumption, and generalized estimation equations were applied as a robustness check to validate the results.

RESULTS: In the intervention group, the unadjusted yearly mean health care costs were €299 the year before receiving Open Dialogue. In the subsequent year, it was €1523, equivalent of a €1224 increase. In corresponding years, the respective health care costs were €208 and €1813 for members of the control group, implying an increase of €1605. The increase in health care costs was driven by psychiatric costs in both groups. Follow-up up to 12 years showed a decrease in total health care costs to €457 in the Open Dialogue group and €938 in the control group. The difference between the groups was not statistically significant.

CONCLUSIONS: This evaluation did not find statistically significant differences in total health care costs between patients receiving Open Dialogue and controls over 12-year follow-up.

SOCIAL MEDIA ABSTRACT: Young patients in treatment with Open Dialogue during acute psychiatric crisis did not have higher total health care costs up to 12-year follow-up compared to controls.