Information about the cost-effectiveness of early intervention programmes for first-episode psychosis is limited.
To evaluate the cost-effectiveness of an intensive early-intervention programme (called OPUS) (trial registration NCT00157313) consisting of enriched assertive community treatment, psychoeducational family treatment and social skills training for individuals with first-episode psychosis compared with standard treatment.
An incremental cost-effectiveness analysis of a randomised controlled trial, adopting a public sector perspective was undertaken.
The mean total costs of OPUS over 5 years (€123,683, s.e. = 8970) were not significantly different from that of standard treatment (€148,751, s.e. = 13073). At 2-year follow-up the mean Global Assessment of Functioning (GAF) score in the OPUS group (55.16, s.d. = 15.15) was significantly higher than in standard treatment group (51.13, s.d. = 15.92). However, the mean GAF did not differ significantly between the groups at 5-year follow-up (55.35 (s.d. = 18.28) and 54.16 (s.d. = 18.41), respectively). Cost-effectiveness planes based on non-parametric bootstrapping showed that OPUS was less costly and more effective in 70% of the replications. For a willingness-to-pay up to €50,000 the probability that OPUS was cost-effective was more than 80%.
The incremental cost-effectiveness analysis showed that there was a high probability of OPUS being cost-effective compared with standard treatment.
Health economic evidence of assertive community treatment (ACT) in Denmark is limited. The aim of the study was to assess the costs and outcome of ACT among 174 patients with severe and persistent mental illness in a rural area of Denmark.
The study was based on a quasi-experimental design with a control group from the neighbouring region. Costs and retention in mental health services were analysed by using register data 1 year before and 4 years after inclusion in the study. Data on the use of supportive housing were available for the year before baseline and the subsequent 2 years only.
Seventy eight percent of the patients receiving ACT were in contact with psychiatric services at the 4-year follow-up, while 69% of the patients in the control group had contact with psychiatric services (P
Information on determinants of duration of untreated psychosis (DUP) is still needed to inform campaigns targeting people with first episode psychosis (FEP). This nation-wide study analysed the association between demographic factors (age, sex, ethnicity, marital status, and geographic area), premorbid and illness-related factors (global functional level, substance misuse, and contact to police), healthcare factors (referral source and first FEP contact) and DUP.
The study population of 1266 patients aged 15-25years diagnosed with FEP (ICD10 F20.0-F20.99) was drawn from the Danish National Indicator Project during 2009-2011. The study population was combined with data from national administrative registers. A multinomial regression model was estimated to analyse the impact of demographic, premorbid and illness-related, and healthcare factors on DUP.
One third of the population had a DUP below 6months. DUP longer than 12months was associated with older age at onset, being female, having cannabis misuse, and living in peripheral municipalities. Being charged by the criminal authorities during one year before FEP was associated with a DUP over 6months.
DUP is related to a number of demographic, premorbid and healthcare factors. These findings suggest that future information campaigns should focus on increasing the awareness of early signs of psychosis not only among mental health professionals but also other professionals in contact with adolescents such as the police. It may also be useful to consider how to target information campaigns towards persons living in peripheral areas.
Most health economic evaluations in mental care include outcome measures aimed at specific aspects of health, like symptom improvement, functional improvement and quality of life instead of generic preference based outcome measures. The health economic guidelines (NICE) recommend to include a generic preference based outcome measure, like EQ-5D, in health economic evaluations in order to allow for comparisons of health related quality of life of patient groups across different diseases, providing information particular useful to support health policy decisions and cost-effectiveness analysis. Although the EQ-5D is by far the most widespread outcome measure within the context of economic evaluations, its validity in psychiatric populations has not yet been established unambiguously. An increasing number of articles have tested the validity of the EQ-5D in comparisons with clinical measures in mental health, but only few studies have addressed the correlation between the EQ-5D and a condition-specific quality of life measure in mental health.
The aim of the article is to test for a potential correlation between the preferred generic outcome measure in health economic evaluations EQ-5D and Manchester Short Assessment of Quality of Life (MANSA) in order to assess to what extent quality of life dimensions measured by a psychiatric quality of life measure are captured in the EQ-5D in a population of patients with schizophrenia and cannabis abuse.
Data analysed is a part of a study of 103 patients with schizophrenia and abuse of cannabis participating in a randomized controlled trial testing a specialized addiction intervention during the period 2008-09. The correlation of the EQ-5D and scores of MANSA was assessed using the Spearman's correlation coefficient. In addition, we tested how the EQ-5D and MANSA correlated with PANSS, GAF and WHO-DAS in order to make comparisons with earlier studies.
We found moderate, statistically significant correlations between the EQ-5D index score and MANSA total score (rho = 0.358**). The dimensions 'Mobility', 'Self-Care' and 'Pain/discomfort' on the EQ-5D were overall not sensitive in this population, while the dimensions 'Usual activities' and 'Anxiety/depression' were moderately correlated with MANSA. The EQ-5D and MANSA both showed statistically significant moderate correlations with the clinical measures in the study PANSS, GAF and WHO-DAS.
Our results suggest that the EQ-5D and MANSA are complementary measures rather than substitutes.
Mental health interventions often seek to improve the patients' quality of life in a broader perspective, like improving the patients' relationship with family, friends and other network, financial situation, employment and accommodation. If the EQ-5D is used as a single outcome in health economic evaluations of e.g. mental health community interventions, these factors may be overlooked. Based on a relatively small sample, we therefore recommend applying the EQ-5D together with condition-specific quality of life measures in future health economic evaluations in mental health.
The early phases of psychosis have been hypothesized to constitute a critical period, a window of opportunity. At the same time, the early phases of psychosis are associated with increased risk of unwanted outcome, such as suicidal behaviour and social isolation. This was the background for the emergence of early intervention services, and in Denmark, the OPUS trial was initiated as part of that process.
Modified assertive community treatment, together with family involvement and social skills training, constituted the core elements in the original programme. A total of 547 patients with first-episode psychosis were included in the trial.
To summarize briefly the results of the OPUS trial: the OPUS treatment was superior to standard treatment in reducing psychotic and negative symptoms and substance abuse, in increasing user satisfaction and adherence to treatment, and in reducing use of bed days and days in supported housing. Moreover, relatives included in the OPUS treatment were less strained and had a higher level of knowledge about schizophrenia and higher user satisfaction.
The OPUS treatment was implemented throughout Denmark. Training courses were developed and manuals and books were published. Regional health authorities had access to national grants for implementing early intervention services; as a result, OPUS teams were disseminated throughout the country. The content of the treatment is now further developed, and new elements are being tried out - such as individual placement and support, lifestyle changes, cognitive remediation, specialized treatment for substance abuse and different kinds of user involvement.