Cost-effectiveness of early intervention in psychosis: systematic review

Abstract

BackgroundEarly intervention in psychosis (EIP) has been developed as an approach to improve the prognosis of people with psychotic disorders and it has been claimed to be a more efficient model of care. However, the evidence is not definitive and doubts have spread regard to the economic outcomes of EIP services amid the usually restricted mental health budget.AimsWe aimed to review the cost-effectiveness evidence of EIP services worldwide.MethodWe systematically reviewed the economic literature about EIP following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement guidelines. Studies were selected according to previously stated criteria and analysed with standardised critical appraisal tools for trial-based economic evaluations and modelling studies.ResultsA total of 16 studies were selected after applying the eligibility criteria. Most of them were economic evaluations alongside clinical trials. The overall evidence was consistent in the cost-effectiveness of EIP compared with standard care for first episode of psychosis and the Clinical High Risk for Psychosis paradigm. Such evidence was replicated among different health systems, but mainly in high-income countries. The methodological quality of such evidence, however, was moderate and heterogeneity was significant across the studies.ConclusionsThere is consistent evidence that the implementation of EIP services might be a cost-effective alternative across different health systems. Such evidence, nevertheless, derives from heterogeneous and sometimes methodologically flawed studies, reducing the certainty of such statement. More efforts must be done to rigorously assess the value of this intervention, before expanding it among systems where mental health budgets are more constrained.Declaration of interestNone.

Economics and mental health: the current scenario

“…Using analytical models to compare EIP with care as usual for people with first‐episode psychosis, results showed that EIP could save around £2,000 per person over 3 years because of improved employment and education outcomes, and approximately £1,000 per person over 4 years because of reduced suicide rates. More recently, a systematic review of 16 studies found consistent evidence of cost‐effectiveness of EIP in people with first‐episode psychosis or clinical high risk for psychosis, compared with care as usual.…”

“…As noted in another systematic review on EIP, indicators that are more valued and relevant to people, health and care systems, and policy makers – such as social recovery, budget impact analyses, and equity measurements – are beginning to be included in the research agenda, although issues such as non‐cashable savings and silo mismatches would be some of the foreseeable challenges with these outcome measures (see below).…”

Early intervention services for psychosis in Ireland: are we there yet?

“…This comes at a pivotal time for Irish mental health services because we are now on the cusp of joining this international movement by rolling out our own EIP services nationally. EIP services have a proven track record of raising the standard of care and treatment, improving outcomes, reducing suffering, limiting the burden of care and reducing costs (Fusar-Poli et al 2017;Correll et al 2018;Aceituno et al 2019). EIP has injected hope into a previously pessimistic view of psychosis (Goldner-Vukov et al 2007;McGorry, 2015).…”

“…Investment will need to be flexible to accommodate the wide variation in demand between rural, urban and metropolitan areas (Kelly et al 2010;Kirkbride, 2015). Although these EIP services are likely to bring with them considerable downstream cost savings (McCrone et al 2008;Park et al 2016;Aceituno et al 2019), these are unlikely to be seen in the first couple of years of operation.…”

Early intervention in psychosis in low‐ and middle‐income countries: a WPA initiative

“…The most consistent evidence is from trials of specialist EIP care versus treatment as usual, which shows better short‐to‐medium clinical and functional outcomes for those receiving EIP care, as well as cost‐effectiveness of EIP, while the evidence of specific effective CHR/UHR interventions to prevent the emergence of psychosis remains unclear.…”