Monday, February 1, 2016

Study Highlights Value of Investing in Intensive, Early Care for Psychosis

Analysis of the Recovery After Initial Schizophrenia Episode (RAISE) trial has found that coordinated specialty care for young people with first-episode psychosis may be more cost-effective than typical community care, according to a study appearing today in Schizophrenia Bulletin.

An earlier report on the NIMH-funded RAISE Early Treatment Program found that patients who receive NAVIGATE, a type of coordinated specialty care, “experienced greater improvement in quality of life and psychopathology, and experienced greater involvement in work and school” compared with controls.

In the current study, Robert Rosenheck, M.D., a professor of psychiatry and public health at Yale University, and colleagues analyzed data from the RAISE program to compare the cost-effectiveness of the NAVIGATE (NAV) intervention package (n=223) with that of standard community care (n=181) over 2 years.

The researchers found that there were no significant differences during the 2-year follow-up period in inpatient service use, with 14% greater mental health or medical surgical days among NAV patients. However, NAV patients received 6.5 (35%) more mental health outpatient visits per 6-month period than community care patients; they also received more clinical, rehabilitation, and family treatment visits, but fewer peer support visits than those in community care. Those additional care visits, plus use of newer medications and increased training for clinicians, contributed to a 27% increase in cost over usual community care, the researchers noted.

The incremental cost-effectiveness ratio was $12,081/Quality of Life Scale (QLS-SD), with a .94 probability that NAV was more cost-effective than community care at $40,000/QLS-SD. When converted to monetized Quality Adjusted Life Years, NAV benefits exceeded costs, especially at future generic drug prices.

“[T]hese additional expenses have now been shown to be worth the investment in improving individuals’ health and functioning,” Robert Heinssen, Ph.D., director of the Division of Services and Intervention Research at NIMH, said in a press release.

For more information, see the Psychiatric News article “Psychosocial Treatments Found Effective for Early Psychosis” and the Psychiatric Services article “The NAVIGATE Program for First-Episode Psychosis: Rationale, Overview, and Description of Psychosocial Components.”

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