Assessing the cost of early intervention in psychosis: a systematic review

Amos, Andrew (2012) Assessing the cost of early intervention in psychosis: a systematic review. Australian and New Zealand Journal of Psychiatry, 46 8: 719-734. doi:10.1177/0004867412450470

Author Amos, Andrew
Title Assessing the cost of early intervention in psychosis: a systematic review
Journal name Australian and New Zealand Journal of Psychiatry   Check publisher's open access policy
ISSN 0004-8674
Publication date 2012-08
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1177/0004867412450470
Volume 46
Issue 8
Start page 719
End page 734
Total pages 16
Place of publication London United Kingdom
Publisher Sage Publications
Collection year 2013
Language eng
Formatted abstract
Objective: Early-intervention units have proliferated over the last decade, justified in terms of cost as well as treatment effect. Strong claims for extension of these programmes on economic grounds motivate a systematic review of economic evaluations of early-intervention programmes.

Method: Searches were undertaken in the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and PsycINFO with keywords including ‘early intervention’, ‘ultra-high risk’, ‘prodrome’, ‘cost-effectiveness’, ‘psychosis’, ‘economic’, and ‘at-risk mental state’. Relevant journals, editorials, and the references of retrieved articles were hand-searched for appropriate research.

Eleven articles were included in the review. The more rigorous research (two randomized control trials and two quasi-experimental studies) suggested no difference in resource utilization or costs between early-intervention and treatment-as-usual groups. One small case-control study with evidence of significant bias concluded annual early-intervention costs were one-third of treatment-as-usual costs. Modelling studies projected reduced costs of early intervention but were based on assumptions since definitively revised. Cost-effectiveness analyses did not strongly support the cost-effectiveness of early intervention. No studies appropriately valued outpatient costs or addressed the feasibility of realizing reduced hospitalization in reduced costs.

Conclusions: The published literature does not support the contention that early intervention for psychosis reduces costs or achieves cost-effectiveness. Past failed attempts to reduce health costs by reducing hospitalization, and increased outpatient costs in early-intervention programmes suggest such programmes may increase costs. Future economic evaluation of early-intervention programmes would need to correctly value outpatient costs and accommodate uncertainty regarding reduced hospitalization costs, perhaps by sensitivity analysis. The current research hints that cost differences may be greater early in treatment and in patients with more severe illness.
Keyword Cost effectiveness analysis
Early intervention in psychosis
Economic evaluation
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2013 Collection
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