Evaluation of the Cost-effectiveness of Services for Schizophrenia in the UK Across the Entire Care Pathway in a Single Whole-Disease Model.
JAMA Netw Open
; 3(5): e205888, 2020 05 01.
Article
en En
| MEDLINE
| ID: mdl-32459356
ABSTRACT
Importance The existing economic models for schizophrenia often have 3 limitations; namely, they do not cover nonpharmacologic interventions, they report inconsistent conclusions for antipsychotics, and they have poor methodologic quality. Objectives:
To develop a whole-disease model for schizophrenia and use it to inform resource allocation decisions across the entire care pathway for schizophrenia in the UK. Design, Setting, andParticipants:
This decision analytical model used a whole-disease model to simulate the entire disease and treatment pathway among a simulated cohort of 200â¯000 individuals at clinical high risk of psychoses or with a diagnosis of psychosis or schizophrenia being treated in primary, secondary, and tertiary care in the UK. Data were collected March 2016 to December 2018 and analyzed December 2018 to April 2019. Exposures The whole-disease model used discrete event simulation; its structure and input data were informed by published literature and expert opinion. Analyses were conducted from the perspective of the National Health Service and Personal Social Services over a lifetime horizon. Key interventions assessed included cognitive behavioral therapy, antipsychotic medication, family intervention, inpatient care, and crisis resolution and home treatment team. Main Outcomes andMeasures:
Life-time costs and quality-adjusted life-years.Results:
In the simulated cohort of 200â¯000 individuals (mean [SD] age, 23.5 [5.1] years; 120â¯800 [60.4%] men), 66â¯400 (33.2%) were not at risk of psychosis, 69â¯800 (34.9%) were at clinical high risk of psychosis, and 63â¯800 (31.9%) had psychosis. The results of the whole-disease model suggest the following interventions are likely to be cost-effective at a willingness-to-pay threshold of £20â¯000 ($25â¯552) per quality-adjusted life-year practice as usual plus cognitive behavioral therapy for individuals at clinical high risk of psychosis (probability vs practice as usual alone, 0.96); a mix of hospital admission and crisis resolution and home treatment team for individuals with acute psychosis (probability vs hospital admission alone, 0.99); amisulpride (probability vs all other antipsychotics, 0.39), risperidone (probability vs all other antipsychotics, 0.30), or olanzapine (probability vs all other antipsychotics, 0.17) combined with family intervention for individuals with first-episode psychosis (probability vs family intervention or medication alone, 0.58); and clozapine for individuals with treatment-resistant schizophrenia (probability vs other medications, 0.81). Conclusions and Relevance The results of this study suggest that the current schizophrenia service configuration is not optimal. Cost savings and/or additional quality-adjusted life-years may be gained by replacing current interventions with more cost-effective interventions.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Esquizofrenia
Tipo de estudio:
Etiology_studies
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Evaluation_studies
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Guideline
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Health_economic_evaluation
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Prognostic_studies
Límite:
Adult
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Female
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Humans
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Male
País/Región como asunto:
Europa
Idioma:
En
Revista:
JAMA Netw Open
Año:
2020
Tipo del documento:
Article
País de afiliación:
Reino Unido