Caragh Behan1, Brendan Kennelly2, Eric Roche3, Laoise Renwick4, Sarah Masterson5, John Lyne6, Brian O'Donoghue7, John Waddington8, Catherine McDonough9, Paul McCrone10, Mary Clarke11. 1. Clinical Research Fellow, Dublin and East Treatment and Early Care Team (DETECT); and Clinical Research Fellow, School of Medicine, University College Dublin, Ireland. 2. Lecturer and Programme Director (Health Economics MSc), Department of Economics, National University of Ireland Galway, Ireland. 3. Clinical Research Fellow, DETECT; and Clinical Research Fellow, School of Medicine, University College Dublin, Ireland. 4. Clinical Nurse Specialist, HRB Nursing and Midwifery Fellow, DETECT, Ireland. 5. Research Assistant, DETECT, Ireland. 6. Consultant Psychiatrist, Beaumont Hospital, Dublin; and Honorary Senior Lecturer, Department of Psychiatry, Royal College of Surgeons in Ireland, Ireland. 7. Senior Research Fellow, Orygen National Centre of Excellence in Youth Mental Health; and Senior Research Fellow, University of Melbourne, Australia. 8. Professor of Neuroscience, Faculty of Medicine and Health Sciences, Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Ireland. 9. Consultant Psychiatrist and Clinical Lead, COPE Early Intervention Service, Cavan and Monaghan Mental Health Services, Ireland. 10. Professor of Health Economics, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK. 11. Clinical Lead, DETECT; and Associate Clinical Professor of Psychiatry, Department of Psychiatry, School of Medicine, University College Dublin, Ireland.
Abstract
BACKGROUND: Early intervention in psychosis is a complex intervention, usually delivered in a specialist stand-alone setting, which aims to improve outcomes for people with psychosis. Previous studies have been criticised because the control used did not accurately reflect actual practice. AIMS: To evaluate the cost-effectiveness of early intervention by estimating the incremental net benefit (INB) of an early-intervention programme, delivered in a real-world setting. INB measures the difference in monetary terms between alternative interventions. METHOD: Two contemporaneous incidence-based cohorts presenting with first-episode psychosis, aged 18-65 years, were compared. Costs and outcomes were measured over 1 year. The main outcome was avoidance of a relapse that required admission to hospital or home-based treatment. RESULTS: From the health sector perspective, the probability that early intervention was cost-effective was 0.77. The INB was €2465 per person (95% CI - €4418 to €9347) when society placed a value of €6000, the cost of an in-patient relapse, on preventing a relapse requiring admission or home care. Following adjustment, the probability that early intervention was cost-effective was 1, and the INB to the health sector was €3105 per person (95% CI -€8453 to €14 663). From a societal perspective, the adjusted probability that early intervention was cost-effective was 1, and the INB was €19 928 per person (95% CI - €2075 to €41 931). CONCLUSIONS: Early intervention has a modest INB from the health sector perspective and a large INB from the societal perspective. The perspective chosen is critical when presenting results of an economic evaluation of a complex intervention.
BACKGROUND: Early intervention in psychosis is a complex intervention, usually delivered in a specialist stand-alone setting, which aims to improve outcomes for people with psychosis. Previous studies have been criticised because the control used did not accurately reflect actual practice. AIMS: To evaluate the cost-effectiveness of early intervention by estimating the incremental net benefit (INB) of an early-intervention programme, delivered in a real-world setting. INB measures the difference in monetary terms between alternative interventions. METHOD: Two contemporaneous incidence-based cohorts presenting with first-episode psychosis, aged 18-65 years, were compared. Costs and outcomes were measured over 1 year. The main outcome was avoidance of a relapse that required admission to hospital or home-based treatment. RESULTS: From the health sector perspective, the probability that early intervention was cost-effective was 0.77. The INB was €2465 per person (95% CI - €4418 to €9347) when society placed a value of €6000, the cost of an in-patient relapse, on preventing a relapse requiring admission or home care. Following adjustment, the probability that early intervention was cost-effective was 1, and the INB to the health sector was €3105 per person (95% CI -€8453 to €14 663). From a societal perspective, the adjusted probability that early intervention was cost-effective was 1, and the INB was €19 928 per person (95% CI - €2075 to €41 931). CONCLUSIONS: Early intervention has a modest INB from the health sector perspective and a large INB from the societal perspective. The perspective chosen is critical when presenting results of an economic evaluation of a complex intervention.
Entities:
Keywords:
First-episode psychosis; community mental health teams; cost-effectiveness; economics; psychotic disorders
Authors: Gemma E Shields; Deborah Buck; Filippo Varese; Alison R Yung; Andrew Thompson; Nusrat Husain; Matthew R Broome; Rachel Upthegrove; Rory Byrne; Linda M Davies Journal: BMC Psychiatry Date: 2022-02-17 Impact factor: 3.630