Impact of a Specialized Early Intervention Service for Psychotic Disorders on Patient Characteristics, Service Use, and Hospital Costs in a Defined Catchment Area

Abstract

Objective:To evaluate the impact of a new early intervention service for first-episode psychosis on patient characteristics, service use, and hospital costs. Method:We examined clinical records of all first admissions to hospitals of patients diagnosed with first-episode psychoses (nonaffective) over a 3-year period before and after the introduction of an early intervention service, the Prevention and Early Intervention Program for Psychosis (PEPP), in a defined catchment area. We examined demographic, clinical, and service use indices covering a 2-year period subsequent to the index admission for each patient.Results: Patients in the post-PEPP phase were significantly younger (P < 0.01), were more often male (P < 0.05), and were less likely to be admitted to hospital with an involuntary status (P < 0.05) or with injuries (P < 0.05) at the time of their first hospital admission. Over the 2 years following the initial admission, post-PEPP patients had significantly fewer admissions to a regular psychiatric service (P < 0.001) and made significantly fewer visits to the hospital emergency department (P < 0.01). There was a significant mean reduction in costs per case of regular hospital bed use ($1028.49, SD 528.02, compared with $792. 28, SD 528.02; P < 0.01) and emergency visits ($519.18, SD 353.79, compared with $353.79, SD 345.0; P < 0.01). Time series analyses followed by Chow tests failed to confirm that these cost changes could be attributed specifically to the introduction of an early intervention service.

Cost-Effectiveness of Comprehensive, Integrated Care for First Episode Psychosis in the NIMH RAISE Early Treatment Program

“…One unanswered question is whether the increased costs of comprehensive first episode psychosis (FEP) programs are offset by reduced inpatient costs, or whether the value of health benefits justifies the additional costs. While it has been reported that early intervention programs reduce hospital days in nonrandomized matched comparisons [8][9][10] and in 1 randomized clinical trial (RCT), 11 only 2 RCT-based cost-effectiveness analyses have been published. 12,13 Both trials found non-significant reductions in costs, although when benefits were assigned monetary values, both suggested that the benefits outweighed costs, albeit at less than the 95% confidence level.…”

Cost-effectiveness of early intervention in first-episode psychosis: economic evaluation of a randomised controlled trial (the OPUS study)

“…[7][8][9] In spite of the rapid development of early-intervention services during the past decade, the evidence base for the health economics of these services is still limited with only a few published studies. [10][11][12][13][14] The current evidence on cost-effectiveness is based on studies with historical controls or studies without enough power in terms of patient numbers to answer health economic questions definitively. 10,15 In particular, the question of whether early-intervention services are cost-effective in the long term has not been addressed.…”

The Role of Untreated Psychosis in Neurodegeneration: A Review of Hypothesized Mechanisms of Neurotoxicity in First-Episode Psychosis

“…Irrespective of the mechanism, early intervention efforts aimed at symptom detection and comprehensive care during the initial stages of illness are a worthwhile initiative for improving clinical, social, and vocational outcomes, [5][6][7] as well as for providing costeffective care. [8][9][10] However, the question of whether untreated psychosis has a neurotoxic effect on the brain has important ethical and legal implications for the use of coercive and involuntary treatment. Indeed, this question remains very difficult to test empirically, given that confounding factors, such as treatment with antipsychotics, [11][12][13][14] cannabis use, 15,16 and other lifestyle habits, 17 have also been found to be associated with changes in brain structure.…”