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Cost-effectiveness of early intervention in first-episode psychosis: economic evaluation of a randomised controlled trial (the OPUS study).

https://arctichealth.org/en/permalink/ahliterature118731
Source
Br J Psychiatry. 2013 Jan;202(1):35-41
Publication Type
Article
Date
Jan-2013
Author
Lene Halling Hastrup
Christian Kronborg
Mette Bertelsen
Pia Jeppesen
Per Jorgensen
Lone Petersen
Anne Thorup
Erik Simonsen
Merete Nordentoft
Author Affiliation
Region Zealand, Psychiatric Research Unit, Roskilde, Denmark. lhhs@regionsjaelland.dk
Source
Br J Psychiatry. 2013 Jan;202(1):35-41
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Antipsychotic Agents - therapeutic use
Community Mental Health Services - economics - organization & administration
Cost-Benefit Analysis
Denmark
Diagnosis-Related Groups - economics
Early Medical Intervention - economics
Family Therapy - economics
Health Care Costs - statistics & numerical data
Health Services - utilization
Humans
Intention to Treat Analysis
Middle Aged
Outcome and Process Assessment (Health Care)
Patient Care Team - economics
Patient Education as Topic - economics
Psychotic Disorders - economics - therapy
Schizophrenia - economics - therapy
Single-Blind Method
Socialization
Young Adult
Abstract
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.
PubMed ID
23174515 View in PubMed
Less detail

The effect of five years versus two years of specialised assertive intervention for first episode psychosis - OPUS II: study protocol for a randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature136300
Source
Trials. 2011;12:72
Publication Type
Article
Date
2011
Author
Marianne Melau
Pia Jeppesen
Anne Thorup
Mette Bertelsen
Lone Petersen
Christian Gluud
Gertrud Krarup
Merete Nordentoft
Author Affiliation
Psychiatric Centre Copenhagen, Copenhagen University, Faculty of Health Sciences, Copenhagen, Denmark. marianne.melau@regionh.dk
Source
Trials. 2011;12:72
Date
2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Antipsychotic Agents - therapeutic use
Cognitive Therapy
Community Mental Health Services
Crisis Intervention
Denmark
Family Therapy
Humans
Psychiatric Status Rating Scales
Psychotherapy, Group
Psychotic Disorders - diagnosis - psychology - therapy
Research Design
Social Behavior
Time Factors
Treatment Outcome
Young Adult
Abstract
The Danish OPUS I trial randomized 547 patients with first-episode psychosis to a two-year early-specialised assertive treatment programme (OPUS) versus standard treatment. The two years OPUS treatment had significant positive effects on psychotic and negative symptoms, secondary substance abuse, treatment adherence, lower dosage of antipsychotic medication, and a higher treatment satisfaction. However, three years after end of the OPUS treatment, the positive clinical effects were not sustained, except that OPUS-treated patients were significantly less likely to be institutionalised compared with standard-treated patients. The major objective of the OPUS II trial is to evaluate the effects of five years of OPUS treatment versus two years of OPUS treatment.
The OPUS II trial is designed as a randomized, open label, parallel group trial with blinded outcome assessment. Based on our sample size estimation, 400 patients treated in OPUS for two years will be randomized to further three years of OPUS treatment versus standard treatment. The specialized assertive OPUS treatment consists of three core elements: assertive community treatment, psycho-educational family treatment, and social skills training.
It has been hypothesized that there is a critical period from onset up to five years, which represents a window of opportunity where a long-term course can be influenced. Extending the specialized assertive OPUS treatment up to five years may allow the beneficial effects to continue beyond the high-risk period, through consolidation of improved social and functional outcome.
Clinical Trial.gov NCT00914238.
Notes
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PubMed ID
21392377 View in PubMed
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From research to practice: how OPUS treatment was accepted and implemented throughout Denmark.

https://arctichealth.org/en/permalink/ahliterature268608
Source
Early Interv Psychiatry. 2015 Apr;9(2):156-62
Publication Type
Article
Date
Apr-2015
Author
Merete Nordentoft
Marianne Melau
Tina Iversen
Lone Petersen
Pia Jeppesen
Anne Thorup
Mette Bertelsen
Carsten Rygaard Hjorthøj
Lene Halling Hastrup
Per Jørgensen
Source
Early Interv Psychiatry. 2015 Apr;9(2):156-62
Date
Apr-2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Combined Modality Therapy
Community Mental Health Services
Denmark
Early Medical Intervention - methods
Family Therapy
Female
Humans
Male
Middle Aged
Patient satisfaction
Program Development
Psychotic Disorders - therapy
Young Adult
Abstract
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.
PubMed ID
24304658 View in PubMed
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Predictors of recovery from psychosis Analyses of clinical and social factors associated with recovery among patients with first-episode psychosis after 5 years.

https://arctichealth.org/en/permalink/ahliterature139496
Source
Schizophr Res. 2011 Feb;125(2-3):257-66
Publication Type
Article
Date
Feb-2011
Author
Nikolai Albert
Mette Bertelsen
Anne Thorup
Lone Petersen
Pia Jeppesen
Phoung Le Quack
Gertrud Krarup
Per Jørgensen
Merete Nordentoft
Author Affiliation
Psychiatric Center Copenhagen, Copenhagen University, Faculty of Health Sciences, Copenhagen, Denmark.
Source
Schizophr Res. 2011 Feb;125(2-3):257-66
Date
Feb-2011
Language
English
Publication Type
Article
Keywords
Adult
Cohort Studies
Combined Modality Therapy
Community Mental Health Services
Denmark
Family Therapy
Female
Follow-Up Studies
Humans
Male
Multivariate Analysis
Patient Education as Topic
Prognosis
Psychiatric Status Rating Scales
Psychotic Disorders - diagnosis - psychology - rehabilitation
Rehabilitation, Vocational
Schizophrenia - diagnosis - rehabilitation
Schizophrenic Psychology
Sex Factors
Social Adjustment
Social Behavior
Young Adult
Abstract
This paper aims to investigate the predictors of good outcome after first-episode non-affective psychosis and the clinical and social trajectories of those that recover.
A cohort of 255 patients with first-episode non-affective psychosis was interviewed 5 years after first diagnosis and treatment. Recovery was defined as working or studying, having a GAF-function score of 60 or above, having remission of negative and psychotic symptoms, and not living in a supported housing facility or being hospitalized during the last 2 years before the five-year follow-up interview.
A total of 40 (15.7%) were found to be recovered, and 76 (29.8%) had a job or were studying after 5 years. Of those working, as many as 20 still had psychotic symptoms. Also notable is that out of the 40 recovered, less than half were recovered after 2 years. Recovery after 5 years was predicted by female sex (OR 2.4, 95% CI 1.0-5.8), higher age (OR 0.91, 95% CI 0.83-0.99), pre-morbid social adaptation (OR 0.72, 95% CI 0.56-0.93), growing up with both parents (OR 2.6, 95% CI 1.0-6.8) and low level of negative symptoms (OR 0.51, 95% CI 0.33 to 0.77) at baseline.
Our findings suggest that a stable social life with normal social functioning has a predictive value for good outcome. These measures might be influenced by negative symptoms, but in the multivariate analysis with negative symptoms included they have an independent effect. Also our findings suggest that, after first-episode psychosis, some patients can still experience psychotic symptoms, but have a job and a fairly stable life.
PubMed ID
21056926 View in PubMed
Less detail

The quality of life among first-episode psychotic patients in the OPUS trial.

https://arctichealth.org/en/permalink/ahliterature98768
Source
Schizophr Res. 2010 Jan;116(1):27-34
Publication Type
Article
Date
Jan-2010
Author
Anne Thorup
Lone Petersen
Pia Jeppesen
Merete Nordentoft
Author Affiliation
Bispebjerg Hospital, Psychiatric Department, Denmark. atv@dadlnet.dk
Source
Schizophr Res. 2010 Jan;116(1):27-34
Date
Jan-2010
Language
English
Publication Type
Article
Keywords
Adult
Assertiveness
Behavior Therapy - methods
Community Mental Health Services
Denmark
Female
Humans
Longitudinal Studies
Male
Psychiatric Status Rating Scales
Psychotic Disorders - psychology - rehabilitation
Quality of Life
Retrospective Studies
Treatment Outcome
Young Adult
Abstract
BACKGROUND: From an 'objective' perspective, treatment of first-episode psychosis has improved in many ways with the development of specialised early and intensive team-based treatment like e.g. the 'OPUS' treatment. However, the patients' perspective is also important and was investigated in the 'OPUS' study by analysing data concerning quality of life. AIM: We aimed to investigate the 'quality of life from patients' perspective' among a cohort of young adults with a first-episode psychosis at the time of treatment initiation and after two years. Especially, we were interested in analysing if there were any significant effects on the subjective quality of life of receiving an intensive psychosocial assertive community treatment called 'OPUS' compared to standard treatment (ST). METHOD: This study is part of the Danish 'OPUS' trial, a randomised controlled trial (RCT) comparing 'treatment as usual' (standard treatment, ST) with 'OPUS' treatment. The Lancashire Quality of Life Profile (LQoLP), which is a combined objective and subjective instrument, was administered at baseline and after two years of treatment, N=280. RESULTS: The intensive 'OPUS' treatment did not affect the quality of life measured by Lancashire QoLP in a significantly different way from the standard treatment (ST). There were no significant differences in quality of life between the ST group and the OPUS group concerning the 9 life domains. Quality of life correlated with psychopathology (both psychotic and negative symptoms) to a minor extent and more strongly with the affective balance and level of self-esteem.
PubMed ID
19897341 View in PubMed
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A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness.

https://arctichealth.org/en/permalink/ahliterature70572
Source
BMJ. 2005 Sep 17;331(7517):602
Publication Type
Article
Date
Sep-17-2005
Author
Lone Petersen
Pia Jeppesen
Anne Thorup
Maj-Britt Abel
Johan Øhlenschlaeger
Torben Østergaard Christensen
Gertrud Krarup
Per Jørgensen
Merete Nordentoft
Author Affiliation
Bispebjerg Hospital, Department of Psychiatry, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark.
Source
BMJ. 2005 Sep 17;331(7517):602
Date
Sep-17-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Assertiveness
Community Mental Health Services - utilization
Female
Follow-Up Studies
Humans
Interpersonal Relations
Male
Middle Aged
Observer Variation
Patient compliance
Patient satisfaction
Psychotic Disorders - therapy
Research Support, Non-U.S. Gov't
Schizophrenia - therapy
Treatment Outcome
Abstract
OBJECTIVES: To evaluate the effects of integrated treatment for patients with a first episode of psychotic illness. DESIGN: Randomised clinical trial. SETTING: Copenhagen Hospital Corporation and Psychiatric Hospital Aarhus, Denmark. PARTICIPANTS: 547 patients with first episode of schizophrenia spectrum disorder. INTERVENTIONS: Integrated treatment and standard treatment. The integrated treatment lasted for two years and consisted of assertive community treatment with programmes for family involvement and social skills training. Standard treatment offered contact with a community mental health centre. MAIN OUTCOME MEASURES: Psychotic and negative symptoms (each scored from 0 to a maximum of 5) at one and two years' follow-up. RESULTS: At one year's follow-up, psychotic symptoms changed favourably to a mean of 1.09 (standard deviation 1.27) with an estimated mean difference between groups of -0.31 (95% confidence interval -0.55 to -0.07, P = 0.02) in favour of integrated treatment. Negative symptoms changed favourably with an estimated difference between groups of -0.36 (-0.54 to -0.17, P
Notes
Comment In: BMJ. 2005 Sep 17;331(7517):586-716166109
Erratum In: BMJ. 2005 Nov 5;331(7524):1065
PubMed ID
16141449 View in PubMed
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Substance abuse and first-episode schizophrenia-spectrum disorders. The Danish OPUS trial.

https://arctichealth.org/en/permalink/ahliterature165411
Source
Early Interv Psychiatry. 2007 Feb;1(1):88-96
Publication Type
Article
Date
Feb-2007
Author
Lone Petersen
Pia Jeppesen
Anne Thorup
Johan Ohlenschlaeger
Gertrud Krarup
Torben Ostergård
Per Jørgensen
Merete Nordentoft
Author Affiliation
Department of Psychiatry E, Bispebjerg Hospital, Copenhagen, Sct Hans Hospital, Roskilde, and Psychiatric Hospital Risskov, Risskov, Denmark. lonepetersen@mail.dk
Source
Early Interv Psychiatry. 2007 Feb;1(1):88-96
Date
Feb-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Community Mental Health Services - methods
Denmark
Diagnosis, Dual (Psychiatry)
Female
Humans
Male
Middle Aged
Psychotic Disorders - complications - diagnosis - therapy
Schizophrenia - complications - diagnosis - therapy
Substance-Related Disorders - complications - diagnosis - therapy
Abstract
To evaluate whether integrated treatment (given by OPUS), in comparison with standard treatment, significantly reduced the number of patients with substance abuse and improved clinical and social outcome in the group of substance abusers after 2 years.
A total of 547 patients with first-episode schizophrenia-spectrum disorders were included in the study, 275 randomly assigned to OPUS treatment and 272 to standard treatment. OPUS treatment consisted of assertive community treatment with family involvement and social skills training. Standard treatment offered contact with a community mental health centre. Main outcome measure was reduction in comorbid substance abuse.
At 2-year follow up, 42 (17.3%) patients from OPUS and 40 (20.7%) patients from standard treatment met criteria for substance abuse (odds ratio=0.5, 95% confidence interval 0.3-1.0). OPUS treatment compared with standard treatment significantly reduced negative and disorganized symptoms in the substance abuser group. Patients with substance abuse in the OPUS treatment spent significantly fewer days in hospital during the 2-year period than patients given standard treatment (109 days vs. 167 days) and adhered to treatment significantly more often.
Results from this trial indicate that integrated treatment given by OPUS reduced substance abuse and improved clinical outcome in the substance abuser group. Supplementing the OPUS treatment with therapeutic programmes for patients with a comorbid substance abuse would probably further improve outcome.
PubMed ID
21352112 View in PubMed
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7 records – page 1 of 1.