An article published in the January 31, 2016 looked at whether it was cost effective to provide comprehensive, multidisciplinary, team-based care for first-episode psychosis (FEP). This article supports the theory that early aggressive intervention in acute psychosis is cost effective and extremely beneficial to patients
“This study provides rigorous evidence that the health benefits exceed the additional costs of the intervention,” lead author Robert Rosenheck, MD, professor of psychiatry and public health, Yale University Medical School, New Haven, Connecticut, told Medscape Medical News.
The researchers used data from the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP), an initiative sponsored by the National Institute of Mental Health (NIMH).
They evaluated the cost-effectiveness of the NAVIGATE (NAV) program for FEP, which includes four core interventions: personalized medication management (assisted by the COMPASS web-based decision support system), family psychoeducation, resilience-focused individual therapy, and supported employment and education.
In the RAISE-ETP study, 223 patients with FEP were randomly assigned to NAV, and 183 similar patients were assigned to standard community care. As previously reported by Medscape Medical News, patients in the NAV program experienced greater improvement in quality of life and psychopathology and were more involved in work and school than their peers who received standard community care. They also remained in treatment longer.
“But the question remained: What are the cost implications of providing early, intensive treatment, and, critically, what is the cost-effectiveness?” Dr Rosenheck said. “Our study shows that NAV costs a total of about 27% more over 2 years, but the benefits justify that increased cost.”
“Thus in all 3 analyses, NAV was both more effective and more costly than [community care], with considerably greater cost-effectiveness among low-DUP clients than among high-DUP clients, and when generic drug prices were used for antipsychotics,” Dr Rosenheck and colleagues report.
But this would call for a change in current clinical practice. “Essentially, what we’ve had for 20 or 30 years is assertive community treatment where we provide very intensive services to the sickest people, those most disabled for a long time. The bold innovation here is now we aren’t waiting to see who does the worst. We are saying, let’s give everybody this intensive treatment early on, which has shown improvements in quality of life, and the piece we’ve now added is that it appears to be cost-effective,” he said.
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