Economic impact of services for first-episode psychosis: A decision model approach

Institute of Psychiatry, King's College London, London, UK.
Early Intervention in Psychiatry (Impact Factor: 1.95). 11/2009; 3(4):266-73. DOI: 10.1111/j.1751-7893.2009.00145.x
Source: PubMed


To assess the impact of early intervention (EI) services on service costs for people with first-episode psychosis.
A decision model was constructed to map the care pathways following input from EI services and from standard care. A Markov process was used to run the model over 18 2-month cycles. Probabilities and costs for the model of admissions, readmissions and use of community services were obtained from the literature, routine sources and expert opinion. One-way and probabilistic sensitivity analyses were conducted to address uncertainty around the parameter estimates.
The model estimated 1 year costs to be £9422 for EI and £14,394 for standard care. The respective figures over 3 years were £26,568 and £40,816. One-way sensitivity analyses revealed that the results were robust to changes in most parameters with the exception of the readmission rate. A relatively small decrease in the readmission rate for standard care patients would eliminate the cost saving. The probabilistic sensitivity analyses also showed that the results were robust to parameter changes.
This study suggests cost savings associated with EI. However, caution is required as the model is relatively simple and relies on a number of assumptions.

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    • "Since the implementation of EIS in England, new evidence has emerged in favour of the cost-effectiveness of the approach (McCrone et al., 2009), the more favourable illness course of those who receive it (Mihalopoulos, 2009), and the fact that EIS improves the engagement and treatment of young people with first episode psychosis compared to traditional community mental health teams (National Collaborating Centre for Mental Health, 2010). Our study adds to this evidence by suggesting that the introduction of EIS in England may have led to a significant fall in DUP. "
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    ABSTRACT: Objective: This study aimed to determine if the inception of Early Intervention Services (EISs) is followed by an improvement in the prompt treatment of people with first episode psychosis. Method: A prospective cohort study of referrals to new and established EISs was conducted at 1, 2, 3, and 4 years after inception of new EIS. The study was conducted with 14 (seven new and seven established) secondary care EIS within geographically defined catchment areas in England between 2005 and 2009. Participants included 1027 consecutive referrals to EIS aged 14-35 with a first episode of psychosis. Duration of untreated psychosis (DUP) and number of participants treated adequately within 6 months of onset were the main outcome measures. Results: A significant downward trend across yearly cohorts for DUP for new EIS (F1,549=8.4, p=0.004) but not for established EIS (F1,429=1.7, p=0.19) was observed. There was a significant upward trend across cohorts in the proportion of referrals treated within 6 months for new EIS (X(2)=8.0, df=1, p=0.005), but not for established EIS (X(2)=0.1, df=1, p=0.72). Conclusion: The introduction of new EIS was followed by a reduction in DUP and an increase in the proportion of patients treated within 6 months of onset. These trends were not present in the catchment areas of established services where DUP was initially lower, suggesting that there was no general tendency for DUP to fall over time. Hence, the introduction of an EIS was followed by an improvement in the prompt and proper treatment of first episode psychosis.
    Full-text · Article · Aug 2014 · Schizophrenia Research
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