Early intervention in psychosis: health economic evaluation using the net benefit approach in a real-world setting.
Br J Psychiatry
; 217(3): 484-490, 2020 09.
Article
in En
| MEDLINE
| ID: mdl-31339083
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.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Psychotic Disorders
Type of study:
Health_economic_evaluation
/
Prognostic_studies
Limits:
Adolescent
/
Adult
/
Aged
/
Humans
/
Middle aged
Language:
En
Journal:
Br J Psychiatry
Year:
2020
Document type:
Article
Affiliation country:
Irlanda