Is early intervention in psychosis cost-effective over the long term?
OBJECTIVE
This study assesses the long-term cost-effectiveness of a comprehensive model of mental health care for first-episode psychosis. The study is an extension of a previous economic evaluation of the Early Psychosis Prevention and Intervention Centre (EPPIC) that assessed the first-year costs and outcomes of treatment.


METHODS
The current study used a matched, historical control group design with a follow-up of approximately 8 years. Complete follow-up data were available for 65 of the original 102 participants. Direct public mental health service costs incurred subsequent to the first year of treatment and symptomatic and functional outcomes of 32 participants initially treated for up to 2 years at EPPIC were compared with a matched cohort of 33 participants initially treated by generic mental health services. Treatment-related resource use was measured and valued using Australian published prices.


RESULTS
Almost 8 years after initial treatment, EPPIC subjects displayed lower levels of positive psychotic symptoms (P = .007), were more likely to be in remission (P = .008), and had a more favorable course of illness (P = .011) than the controls. Fifty-six percent of the EPPIC cohort were in paid employment over the last 2 years compared with 33% of controls (P = .083). Each EPPIC patient costs on average A$3445 per annum to treat compared with controls, who each costs A$9503 per annum.


CONCLUSIONS
Specialized early psychosis programs can deliver a higher recovery rate at one-third the cost of standard public mental health services. Residual methodological limitations and limited sample size indicate that further research is required to verify this finding.
Mihalopoulos
Cathrine
C
Deakin Health Economics, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia. cathy.mihalopoulos@deakin.edu.au
Harris
Meredith
M
Henry
Lisa
L
Harrigan
Susy
S
McGorry
Patrick
P
D000328:Adult; D001315:Australia; D010054:Brief Psychiatric Rating Scale / Q000706:statistics & numerical data; D016022:Case-Control Studies; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000191:economics; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008134:Long-Term Care / Q000191:economics; D008297:Male; D011594:Psychometrics; D011618:Psychotic Disorders / Q000191:economics* / Q000517:prevention & control / Q000534:rehabilitation*; D015980:Public Health Practice / Q000191:economics; D011788:Quality of Life / Q000523:psychology; D012050:Rehabilitation, Vocational; D012559:Schizophrenia / Q000191:economics* / Q000517:prevention & control / Q000534:rehabilitation*; D012565:Schizophrenic Psychology; D055815:Young Adult