Schizophrenia Bulletin Advance Access originally published online on June 9, 2009
Schizophrenia Bulletin 2009 35(5):909-918; doi:10.1093/schbul/sbp054
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Is Early Intervention in Psychosis Cost-Effective Over the Long Term?
2 Deakin Health Economics, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
3 School of Population Health, University of Queensland, Queensland 4072, Australia
4 Orygen Research Centre, 35 Poplar Road, Parkville, Victoria 3052, Australia
5 Department of Psychiatry, The University of Melbourne, Victoria 3010, Australia
1 To whom correspondence should be addressed; tel: +61-3-9251-7383, fax: +61-3-9244-6624, e-mail: cathy.mihalopoulos{at}deakin.edu.au.
Objective: This study assesses the long-term cost-effectiveness of a comprehensive model of mental health care for first-episode psychosis. The study is an extension of a previous economic evaluation of the Early Psychosis Prevention and Intervention Centre (EPPIC) that assessed the first-year costs and outcomes of treatment. Method: The current study used a matched, historical control group design with a follow-up of approximately 8 years. Complete follow-up data were available for 65 of the original 102 participants. Direct public mental health service costs incurred subsequent to the first year of treatment and symptomatic and functional outcomes of 32 participants initially treated for up to 2 years at EPPIC were compared with a matched cohort of 33 participants initially treated by generic mental health services. Treatment-related resource use was measured and valued using Australian published prices. Results: Almost 8 years after initial treatment, EPPIC subjects displayed lower levels of positive psychotic symptoms (P = .007), were more likely to be in remission (P = .008), and had a more favorable course of illness (P = .011) than the controls. Fifty-six percent of the EPPIC cohort were in paid employment over the last 2 years compared with 33% of controls (P = .083). Each EPPIC patient costs on average A$3445 per annum to treat compared with controls, who each costs A$9503 per annum. Conclusions: Specialized early psychosis programs can deliver a higher recovery rate at one-third the cost of standard public mental health services. Residual methodological limitations and limited sample size indicate that further research is required to verify this finding.
Keywords: economic evaluation / psychotic disorders / mental health care