Economic consequences of alternative medication strategies in first episode non-affective psychosis.
BACKGROUND
Maintenance treatment appears to be successful in preventing relapses in first episode psychosis, but is also associated with side effects. Guided discontinuation strategy is a less intrusive intervention, but may lead to more relapses. In the current economic evaluation, costs and health outcomes of discontinuation strategy will be compared with the results of maintenance treatment in patients with remitted first episode psychosis.


METHODS
The study was designed as a randomised clinical trial. In total 128 patients were prospectively followed for 18 months after six months of stable remission. The economic evaluation was conducted from a societal perspective. Quality-adjusted life years (QALYs) were used as primary health outcome in the economic evaluation. Relapse rates were assessed in addition to various other secondary outcomes.


RESULTS
There were no relevant differences in mean costs between groups during the study. Total costs were largely influenced by costs related to admissions to psychiatric hospitals. No differences between groups were found for QALY results.


CONCLUSIONS
There were no indications that either of the examined interventions is superior to the other in terms of costs or QALY results. Additional results indicated that the relapse rate in discontinuation strategy was twice as high, but without an increase in hospital admissions or negative consequences on other clinical outcomes. For a minority of remitted first episode patients, guided discontinuation strategy may offer a feasible alternative to maintenance treatment.
Stant
A D
AD
Office for Medical Technology Assessment, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands. a.d.stant@mta.umcg.nl
TenVergert
E M
EM
Wunderink
L
L
Nienhuis
F J
FJ
Wiersma
D
D
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D017046:Cost Savings / Q000706:statistics & numerical data; D004334:Drug Administration Schedule; D016527:Drug Costs / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000191:economics; D008297:Male; D009313:National Health Programs / Q000191:economics*; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000188:drug therapy / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D012559:Schizophrenia / Q000188:drug therapy / Q000191:economics*
D014150:Antipsychotic Agents