Cost-effectiveness of treating first episode psychosis. Five-year follow-up results from an Italian early intervention program

Department of Mental Health, Center for early detection and intervention in psychosis-Programma2000, Niguarda Ca' Granda Hospital, Milan, Italy.
Early Intervention in Psychiatry (Impact Factor: 1.95). 08/2011; 5(3):203-11. DOI: 10.1111/j.1751-7893.2011.00261.x
Source: PubMed


Early intervention programmes are expected to result in the reduction of illness severity in patients with schizophrenia, and contain health-care costs by reducing hospital admissions and improving the social functioning of patients. This study aimed to investigate the cost-effectiveness of treatment in an early intervention programme in comparison to standard care.
Retrospective analysis of data prospectively recorded in an urban area (Milan, Italy). Twenty-three patients from an early intervention programme and 23 patients from standard care with first-episode psychosis were evaluated on their use of services over a 5-year period. The Health of the Nation Outcome Scale was used to measure clinical status.
Significant changes with respect to initial assessment were recorded on the Health of the Nation Outcome Scale, with larger effect sizes in the early intervention programme than in the standard care group. Consequently, the cost-effectiveness ratio per reduced score of severity was lower in the early intervention programme than in standard care (€ 4802 vs. € 9871), with an incremental cost-effectiveness ratio, or net saving of €-1204 for every incremental reduced score of severity. Over time, greater recourse to hospital and residential facilities to obtain comparable improvement in symptoms resulted in a steady cost increase for the patients in standard care.
Allocation of funds to specialized early intervention programmes is the best alternative, as it can save costs by reducing the use of hospitals and residential facilities, and may produce net savings of costs in the long term.

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    • "The total economic burden of schizophrenia is comparable to the total costs of any other mental disorder. In most of the developed countries, current healthcare expenditure on schizophrenia accounts for 1.6% to 2.5% of the total healthcare budget [5,6]. Schizophrenia is a chronic mental illness associated with a significant and long-lasting health, social, and financial burden due to expenditures for hospitalization, treatment and rehabilitation, reduced and lost productivity [5-10]. "
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    ABSTRACT: Schizophrenia is a severe psychotic disorder characterized by significant disturbances in thinking, perception, emotions and behavior. Even if it is not a very frequent disorder, but it is the most burdensome and costly illnesses worldwide. The total population was approximate 1.3 billion and there are approximate 8 million schizophrenic patients in China. Despite the wide-ranging financial and social burdens associated with schizophrenia, but there have been few cost-of-illness studies of this illness in China. To evaluate the economic cost of schizophrenic patients in China.Methodology: 356 schizophrenic patients who met with DSM-IV criteria were enrolled and investigated with the Economic Burden Questionnaire(EBQ), 299 schizophrenic patients completed the study for 12 months. All the data were combined and classified by researcher. EBQ include all kinds of cost such as direct cost, indirect cost and total cost as well. It was filled in by patients and their close caregivers. Comparison of cost was made between not only out-patients and in-patients but also urban patients and rural patients. Multiple stepwise regression analysis was made to identify the main influence factors of total cost. (i)The per case per annum total costs, direct costs and indirect costs of schizophrenia amounted to US$2586.21, US$862.81(33.4%)and US$1723.40(66.6%)respectively. The per case total cost, direct cost and direct medical cost of in-patients were more higher than out-patients(P < 0.05). (ii)There was significant difference in per case per annum total cost, direct cost, direct medical cost, cost due to lost working-days and disability between urban and rural schizophrenic patients(P < 0.05), the former is higher than the latter. (iii) The results of multivariate stepwise regression analysis show that five variables were significantly correlated with higher cost: professional status(cadre), diagnostic subtype(residual schizophrenia), urban or rural patients(urban patients), in-patients or out-patients(in-patients) and researcher centre(southern center). The standardized regression coefficient were 0.308, 0.218, 0.212, 0.156 and 0.149 respectively, the correlation of determination R square was 0.2741, F = 15.651, P < 0.0000. These characteristics explain 27.41% of the variability in the total cost. (i) Economic cost of schizophrenia were serious, we must pay close attention to it. (ii) The indirect cost are the majority of the total cost. The cost of urban patients are more higher than the cost of rural patients, the cost of in-patients are more higher than the cost of out-patients.
    International Journal of Mental Health Systems 11/2013; 7(1):26. DOI:10.1186/1752-4458-7-26 · 1.06 Impact Factor
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    • "The costs for patients, their families and society are huge, and largely generated by the direct cost of care, especially hospitalization [5-7]. Even higher costs arise from lost productivity (unemployment of patients and absence from work by the relatives who care for them), informal care, criminal justice service involvement, and social security expenditure [8,9]. "
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    ABSTRACT: Psychoses within the spectrum of schizophrenia are severe mental disorders with a high chance of long-term disability and a negative impact on the quality of life. Poor adherence to pharmacotherapy negatively affects the course and the outcome of these disorders, enhancing the risk of relapse and readmission. Falloon and coworkers developed a Psychoeducation Program aimed at improving communication and problem-solving abilities in patients and their families. This study set out to evaluate changes in adherence to pharmacotherapy in a sample of patients diagnosed with schizophrenia-spectrum psychoses, by comparing one group exposed to the Falloon Psychoeducation Program with another group exposed to family supportive therapy with generic information on the disorders. 340 patients diagnosed with schizophrenia and related disorders according to standardized criteria from 10 participating units distributed throughout the Italian National Health System, will be enrolled with 1:1 allocation by the method of blocks of randomized permutations. Patients will be reassessed at 6, 12 and 18 months after start of treatment (duration: 6 months).The primary objective is to evaluate changes in adherence to pharmacotherapy after psychoeducation. Adherence will be assessed at three-month intervals by measuring blood levels of the primary prescribed drug using high pressure liquid chromatography, and via the Medication Adherence Questionnaire and a modified version of the Adherence Interview. Secondary objectives are changes in the frequency of relapse and readmission, as the main indicator of the course of the disorder.Enrolled patients will be allocated to the Falloon Psychoeducation Program (yes/no) randomly, 1:1, in a procedure controlled by the coordinating unit; codes will be masked until the conclusion of the protocol (or the occurrence of a severe negative event). The raters assessing the outcomes will be blind to treatment allocation and will be tested for blinding after treatment completion. Intention-to-treat will be applied in considering the primary and secondary outcomes. Multiple imputations will be applied to integrate the missing data. The study will start recruitment in February 2013; the total duration of the study is 27 months. If the psychoeducation program proves effective in improving adherence to pharmacotherapy and in reducing relapse and readmissions, its application could be proposed as a standard adjunctive psychosocial treatment within the Italian National Health System.Trial registration: Protocol Registration System of NCT01433094; registered on 20 August 2011; first patient was randomized on 12 February 2013.
    Trials 10/2013; 14(1):323. DOI:10.1186/1745-6215-14-323 · 1.73 Impact Factor
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    • "Indeed, a detailed assessment at intake can allow the prescription of the best, tailored treatment. Improved allocation of the resources available to treatment may also cut costs [58]. This is a clear advantage in an era of financial crisis and saving on costs. "
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    ABSTRACT: Objective: This study aimed at defining the characteristics of a population of patients diagnosed with first-episode psychosis (FEP), and accessing for the first time a center for early intervention in psychosis in the health district of Milan and its surroundings. Methods: Patients were included in the study from January 2007 to December 2008; criteria: first contact with any public mental health service of the catchment area for a first episode of schizophrenia or related syndromes according to the ICD-10 criteria. Cluster analysis was used to divide patients into groups based on the main socio-demographic and clinical characteristics at presentation. Results: Overall, 91 FEP patients were enrolled in the study. Two clusters were identified, which differed principally by symptom profile. Patients in cluster 1 (n=36) had severe agitation, and a history of alcohol and/or substance abuse at presentation more often than those in cluster 2 (n=55), who were more likely to suffer at presentation from severe depression or apathy, anxiety, poor self-care, functional or work impairment and severe social withdrawal. After six months of treatment patients improved on almost all symptomatic dimensions on the Health of the Nation Outcome Scale and the Brief Psychiatric Rating Scale, with greater improvement in cluster 1 than in cluster 2. Conclusions: The findings of this study need replication in larger samples and on a wider severity scale. Nevertheless, the heterogeneity of patients with FEP might impact on treatment. Policymakers should recognize the importance of the diagnostic and outcome assessment in the treatment of severe mental disorders.
    Clinical Practice and Epidemiology in Mental Health 01/2013; 10(1):1-8. DOI:10.2174/1745017901410010001
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