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Schizophr Bull. 2016 Jul;42(4):896-906. doi: 10.1093/schbul/sbv224. Epub 2016 Jan 31.

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

Author information

1
Department of Psychiatry and Public Health, Yale Medical School, New Haven, CT; Robert.Rosenheck@Yale.Edu.
2
Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA;
3
Department of Psychiatry and Public Health, Yale Medical School, New Haven, CT;
4
Psychiatry Research, Zucker Hillside Hospital, North Shore-Long Island Jewish, Glen Oaks, NY; Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY; Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY;
5
Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychiatry, and Psychology, Boston University, Boston, MA;
6
Department of Psychology, University of North Carolina-Chapel Hill, Chapel Hill, NC; School of Psychology, Australian Catholic University, Melbourne, Australia;
7
Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Canada;
8
Geisel School of Medicine at Dartmouth, Lebanon, NH; Bureau of Behavioral Health, DHHS, Concord, NH;
9
Department of Social Medicine, University of North Carolina, Chapel Hill, NC;
10
Psychiatry Research, Zucker Hillside Hospital, North Shore-Long Island Jewish, Glen Oaks, NY;
11
Nathan Kline Institute, Orangeburg, NY;
12
National Institute of Mental Health, Rockville, MD.

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

PMID:
26834024
PMCID:
PMC4903057
DOI:
10.1093/schbul/sbv224
[Indexed for MEDLINE]
Free PMC Article

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