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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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| Published in: | Schizophrenia bulletin 2016-07, Vol.42 (4), p.896-906 |
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| Main Authors: | , , , , , , , , , , , , , , , , , |
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| cites | cdi_FETCH-LOGICAL-c453t-a293dd0db276067cb8d3ffd45165d60554370ee2007211dfdac1c2a0764a5bd03 |
| container_end_page | 906 |
| container_issue | 4 |
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| container_title | Schizophrenia bulletin |
| container_volume | 42 |
| creator | 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 |
| description | 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. |
| doi_str_mv | 10.1093/schbul/sbv224 |
| format | article |
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When converted to monetized Quality Adjusted Life Years, NAV benefits exceeded costs, especially at future generic drug prices.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Community Mental Health Services - economics</subject><subject>Community Mental Health Services - standards</subject><subject>Cost-Benefit Analysis</subject><subject>Delivery of Health Care, Integrated - economics</subject><subject>Delivery of Health Care, Integrated - standards</subject><subject>Female</subject><subject>Health Services Research</subject><subject>Humans</subject><subject>Male</subject><subject>National Institute of Mental Health (U.S.)</subject><subject>Outcome Assessment, Health Care</subject><subject>Patient Care Team - economics</subject><subject>Patient Care Team - standards</subject><subject>Psychotic Disorders - economics</subject><subject>Psychotic Disorders - therapy</subject><subject>Regular</subject><subject>Schizophrenia - economics</subject><subject>Schizophrenia - therapy</subject><subject>United States</subject><subject>Young Adult</subject><issn>0586-7614</issn><issn>1745-1701</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNpVkUFv1DAQRi0EokvhyBX5yIFQ27Hj5IJURSldqUAF5Ww59rgJSuLF411p-fUEbangNNLM0zejeYS85uw9Z015gW7o99MF9gch5BOy4VqqgmvGn5INU3VV6IrLM_IC8QdjXDaVeE7ORFWXkgm5Ib_aiLnoQgCXxwMsgEhjoG2cdwkGWHBtvqPbJcN9shk8bW0CGmKiV2PCTLvdiNEDvcWjGyKOSMeF5gHo5-2na_r1cvuto51N05HeJbB5hiXT2xTXsPkleRbshPDqoZ6T71fdXXtd3Hz5uG0vbwonVZkLK5rSe-Z7oStWadfXvgzBS8Ur5SumlCw1AxCMacG5D9467oRlupJW9Z6V5-TDKXe372fwbj0h2cns0jjbdDTRjub_yTIO5j4ejGxYyZReA94-BKT4cw-YzTyig2myC8Q9Gq7Xr0pVN_WKFifUpYiYIDyu4cz88WVOvszJ18q_-fe2R_qvoPI3RViVFA</recordid><startdate>20160701</startdate><enddate>20160701</enddate><creator>Rosenheck, Robert</creator><creator>Leslie, Douglas</creator><creator>Sint, Kyaw</creator><creator>Lin, Haiqun</creator><creator>Robinson, Delbert G</creator><creator>Schooler, Nina R</creator><creator>Mueser, Kim T</creator><creator>Penn, David L</creator><creator>Addington, Jean</creator><creator>Brunette, Mary F</creator><creator>Correll, Christoph U</creator><creator>Estroff, Sue E</creator><creator>Marcy, Patricia</creator><creator>Robinson, James</creator><creator>Severe, Joanne</creator><creator>Rupp, Agnes</creator><creator>Schoenbaum, Michael</creator><creator>Kane, John M</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160701</creationdate><title>Cost-Effectiveness of Comprehensive, Integrated Care for First Episode Psychosis in the NIMH RAISE Early Treatment Program</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c453t-a293dd0db276067cb8d3ffd45165d60554370ee2007211dfdac1c2a0764a5bd03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Community Mental Health Services - economics</topic><topic>Community Mental Health Services - standards</topic><topic>Cost-Benefit Analysis</topic><topic>Delivery of Health Care, Integrated - economics</topic><topic>Delivery of Health Care, Integrated - standards</topic><topic>Female</topic><topic>Health Services Research</topic><topic>Humans</topic><topic>Male</topic><topic>National Institute of Mental Health (U.S.)</topic><topic>Outcome Assessment, Health Care</topic><topic>Patient Care Team - economics</topic><topic>Patient Care Team - standards</topic><topic>Psychotic Disorders - economics</topic><topic>Psychotic Disorders - therapy</topic><topic>Regular</topic><topic>Schizophrenia - economics</topic><topic>Schizophrenia - therapy</topic><topic>United States</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rosenheck, Robert</creatorcontrib><creatorcontrib>Leslie, Douglas</creatorcontrib><creatorcontrib>Sint, Kyaw</creatorcontrib><creatorcontrib>Lin, Haiqun</creatorcontrib><creatorcontrib>Robinson, Delbert G</creatorcontrib><creatorcontrib>Schooler, Nina R</creatorcontrib><creatorcontrib>Mueser, Kim T</creatorcontrib><creatorcontrib>Penn, David L</creatorcontrib><creatorcontrib>Addington, Jean</creatorcontrib><creatorcontrib>Brunette, Mary F</creatorcontrib><creatorcontrib>Correll, Christoph U</creatorcontrib><creatorcontrib>Estroff, Sue E</creatorcontrib><creatorcontrib>Marcy, Patricia</creatorcontrib><creatorcontrib>Robinson, James</creatorcontrib><creatorcontrib>Severe, Joanne</creatorcontrib><creatorcontrib>Rupp, Agnes</creatorcontrib><creatorcontrib>Schoenbaum, Michael</creatorcontrib><creatorcontrib>Kane, John M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Schizophrenia bulletin</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rosenheck, Robert</au><au>Leslie, Douglas</au><au>Sint, Kyaw</au><au>Lin, Haiqun</au><au>Robinson, Delbert G</au><au>Schooler, Nina R</au><au>Mueser, Kim T</au><au>Penn, David L</au><au>Addington, Jean</au><au>Brunette, Mary F</au><au>Correll, Christoph U</au><au>Estroff, Sue E</au><au>Marcy, Patricia</au><au>Robinson, James</au><au>Severe, Joanne</au><au>Rupp, Agnes</au><au>Schoenbaum, Michael</au><au>Kane, John M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cost-Effectiveness of Comprehensive, Integrated Care for First Episode Psychosis in the NIMH RAISE Early Treatment Program</atitle><jtitle>Schizophrenia bulletin</jtitle><addtitle>Schizophr Bull</addtitle><date>2016-07-01</date><risdate>2016</risdate><volume>42</volume><issue>4</issue><spage>896</spage><epage>906</epage><pages>896-906</pages><issn>0586-7614</issn><eissn>1745-1701</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><notes>ObjectType-Undefined-3</notes><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.</abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>26834024</pmid><doi>10.1093/schbul/sbv224</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Schizophrenia bulletin, 2016-07, Vol.42 (4), p.896-906 |
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| language | eng |
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| source | PubMed (Medline); Oxford Journals |
| 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 |
| title | Cost-Effectiveness of Comprehensive, Integrated Care for First Episode Psychosis in the NIMH RAISE Early Treatment Program |
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