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Economic Evaluation of Extended Early Intervention Service vs Regular Care Following 2 Years of Early Intervention: Secondary Analysis of a Randomized Controlled Trial
Open accessAbstract
Cost-effectiveness studies of early intervention services (EIS) for psychosis have not included extension beyond the first 2 years. We sought to evaluate the cost-effectiveness of a 3-year extension of EIS compared to regular care (RC) from the public health care payer’s perspective. Following 2 years of EIS in a university setting in Montreal, Canada, patients were randomized to a 3-year extension of EIS (n = 110) or RC (n = 110). Months of total symptom remission served as the main outcome measure. Resource use and cost data for publicly covered health care services were derived mostly from administrative systems. The incremental cost-effectiveness ratio (ICER) and cost-effectiveness acceptability curve were produced. Relative cost-effectiveness was estimated for those with duration of untreated psychosis (DUP) of 12 weeks or less vs longer. Extended early intervention had higher costs for psychiatrist and nonphysician interventions, but total costs were not significantly different. The ICER was $1627 per month in total remission. For the intervention to have an 80% chance of being cost-effective, the decision-maker needs to be willing to pay $5942 per month of total symptom remission. DUP ≤ 12 weeks was associated with a reduction in costs of $12 276 even if no value is placed on additional months in total remission. Extending EIS for psychosis for people, such as those included in this study, may be cost-effective if the decision-maker is willing to pay a high price for additional months of total symptom remission, though one commensurate with currently funded interventions. Cost-effectiveness was much greater for people with DUP ≤12 weeks.
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Evidence consistently shows cost-effectiveness of early interventions in psychosis across different health systems.
“Evidence consistently shows cost-effectiveness of early interventions in psychosis across different health systems.”
From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [420]
The Introduction (page unavailable) reports that earlier studies found cost-effectiveness for early intervention services during the first two years. But the Abstract and Discussion (pages unavailable) describe this study’s extended service as potentially cost-effective only under a high willingness-to-pay threshold, and the paper does not establish consistent cost-effectiveness across different health systems. (LLM, conf=0.85)
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The Lancet Psychiatry Commission on youth mental health
McGorry, P. D., Mei, C., Dalal, N., Alvarez-Jimenez, M., Blakemore, S.-J., Browne, V., Dooley, B., Hickie, I. B., Jones, P. B., McDaid, D., et al. (2024) · The Lancet Psychiatry · doi:10.1016/s2215-0366(24)00163-9 · Cited by 663
Self-citation
Metadata
- Authors
- Groff, M., Latimer, E., Joober, R., Iyer, S. N., Schmitz, N., Abadi, S., Abdel-Baki, A., Casacalenda, N., Margolese, H. C., Jarvis, G. E., & Malla, A.
- Affiliations
- Douglas Mental Health University Institute (CA)
- University of Montreal Hospital Centre, Montreal, QC, Canada
- Jewish General Hospital (CA)
- McGill University Health Centre (CA)
- Corresponding author
- Latimer, Eric
- ORCID
- Venue
- Schizophrenia Bulletin
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-09-12
- Volume
- 47
- Issue
- 2
- Pages
- 465-473
- ISSN
- 0586-7614 (ISSN-L)
- 1745-1701
- PMC
- PMC7965062
- OpenAlex
- W3084796914
- Cited by
- 13
- References
- 3
- Citations by year
- 2024: 3 · 2023: 1 · 2022: 4 · 2021: 5
- FWCI
- 1.82
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Schizophrenia Bulletin (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research
- Canada Research Chairs
- Fonds de recherche du Québec - Santé
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- early intervention in psychosis
- MeSH terms
- Adolescent, Adult, Cost-Benefit Analysis, Female, Humans, Male, Psychotic Disorders, Remission Induction, Health Care Costs, Outcome Assessment, Health Care, Young Adult, Early Medical Intervention
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