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

Robert Rosenheck, Douglas Leslie, Kyaw Sint, Haiqun Lin, Delbert G Robinson, Nina R Schooler, Kim T Mueser, David L Penn, Jean Addington, Mary F Brunette, Christoph U Correll, Sue E Estroff, Patricia Marcy, James Robinson, Joanne Severe, Agnes Rupp, Michael Schoenbaum, John M Kane, Robert Rosenheck, Douglas Leslie, Kyaw Sint, Haiqun Lin, Delbert G Robinson, Nina R Schooler, Kim T Mueser, David L Penn, Jean Addington, Mary F Brunette, Christoph U Correll, Sue E Estroff, Patricia Marcy, James Robinson, Joanne Severe, Agnes Rupp, Michael Schoenbaum, John M Kane

Abstract

This study compares the cost-effectiveness of Navigate (NAV), a comprehensive, multidisciplinary, team-based treatment approach for first episode psychosis (FEP) and usual Community Care (CC) in a cluster randomization trial. Patients at 34 community treatment clinics were randomly assigned to either NAV (N = 223) or CC (N = 181) for 2 years. Effectiveness was measured as a one standard deviation change on the Quality of Life Scale (QLS-SD). Incremental cost effectiveness ratios were evaluated with bootstrap distributions. The Net Health Benefits Approach was used to evaluate the probability that the value of NAV benefits exceeded its costs relative to CC from the perspective of the health care system. The NAV group improved significantly more on the QLS and had higher outpatient mental health and antipsychotic medication costs. The incremental cost-effectiveness ratio was $12 081/QLS-SD, with a .94 probability that NAV was more cost-effective than CC at $40 000/QLS-SD. When converted to monetized Quality Adjusted Life Years, NAV benefits exceeded costs, especially at future generic drug prices.

Keywords: cost-effectiveness; quality adjusted life years; schizophrenia.

Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center 2016.

Figures

Fig. 1.
Fig. 1.
Bootstrap analysis of the incremental cost-effectiveness ratio (ICER) for Navigate vs Community Care (NAV vs CC): full sample over 2 years.
Fig. 2.
Fig. 2.
Bootstrap analysis of the incremental cost-effectiveness ratio (ICER) for Navigate vs Community Care (NAV vs CC): low-DUP Sample over 2 years. DUP = duration of untreated psychosis.
Fig. 3.
Fig. 3.
Bootstrap analysis of the incremental cost-effectiveness ratio (ICER) for Navigate vs Community Care (NAV vs CC): High-DUP sample over 2 years. DUP = duration of untreated psychosis.
Fig. 4.
Fig. 4.
Bootstrap analysis of the incremental cost-effectiveness ratio (ICER) for Navigate vs Community Care (NAV vs CC): Full sample with generic medication costs over 2 years.
Fig. 5.
Fig. 5.
Cost effectiveness acceptability curve (Navigate vs Community Care [NAV vs CC]).
Fig. 6.
Fig. 6.
Cost effectiveness acceptability curve (Navigate vs Community Care [NAV vs CC]; low duration of untreated psychosis [DUP]).
Fig. 7.
Fig. 7.
Cost effectiveness acceptability curve (Navigate vs Community Care [NAV vs CC]; high duration of untreated psychosis [DUP]).

Source: PubMed

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