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

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 eithe...

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Bibliographic Details
Published in:Schizophrenia bulletin 2016-07, Vol.42 (4), p.896-906
Main Authors: Rosenheck, Robert, Leslie, Douglas, Sint, Kyaw, Lin, Haiqun, Robinson, Delbert G, Schooler, Nina R, Mueser, Kim T, Penn, David L, Addington, Jean, Brunette, Mary F, Correll, Christoph U, Estroff, Sue E, Marcy, Patricia, Robinson, James, Severe, Joanne, Rupp, Agnes, Schoenbaum, Michael, Kane, John M
Format: Article
Language:English
Subjects:
Adolescent
Adult
Community Mental Health Services - economics
Community Mental Health Services - standards
Cost-Benefit Analysis
Delivery of Health Care, Integrated - economics
Delivery of Health Care, Integrated - standards
Female
Health Services Research
Humans
Male
National Institute of Mental Health (U.S.)
Outcome Assessment, Health Care
Patient Care Team - economics
Patient Care Team - standards
Psychotic Disorders - economics
Psychotic Disorders - therapy
Regular
Schizophrenia - economics
Schizophrenia - therapy
United States
Young Adult
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Summary: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.
ISSN:0586-7614
1745-1701
DOI:10.1093/schbul/sbv224