title: Cost-effectiveness of preventing first-episode psychosis in ultra-high-risk subjects: multi-centre randomized controlled trial.
abstract: BACKGROUND
  Although there is evidence for the effectiveness of interventions for psychosis among ultra-high-risk (UHR) groups, health economic evaluations are lacking. This study aimed to determine the cost effectiveness and cost-utility of cognitive-behavioural therapy (CBT) to prevent first-episode psychosis.
  
  
  METHODS
  The Dutch Early Detection and Intervention Evaluation study was a randomized controlled trial of 196 UHR patients with an 18-month follow-up. All participants were treated with routine care (RC) for non-psychotic disorders. The experimental group (n = 95) received add-on CBT to prevent first-episode psychosis. We report the intervention, medical and travel costs, as well as costs arising from loss of productivity. Treatment response was defined as psychosis-free survival and quality-adjusted life years (QALYs) gained.
  
  
  RESULTS
  In the cost-effectiveness analysis, the proportion of averted psychoses was significantly higher in the CBT condition (89.5% v. 76.2%). CBT showed a 63.7% probability of being more cost effective, because it was less costly than RC by US$844 (£551) per prevented psychosis. In the cost-utility analysis, QALY health gains were slightly higher for CBT than for RC (0.60 v. 0.57) and the CBT intervention had a 52.3% probability of being the superior treatment because, for equal or better QALY gains, the costs of CBT were lower than those of RC.
  
  
  CONCLUSIONS
  Add-on preventive CBT for UHR resulted in a significant reduction in the incidence of first psychosis. QALY gains show little difference between the two conditions. The CBT intervention proved to be cost saving.
authors.affiliation: Department of Psychosis Research,Parnassia Psychiatric Institute,The Hague,The Netherlands.
authors.forename: H K
authors.initials: HK
authors.lastname: Ising
authors.affiliation: Department of Clinical Psychology,VU University and EMGO Institute for Health and Care Research,Amsterdam,The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Smit
authors.affiliation: Department of Psychiatry,University Medical Center Groningen,Groningen,The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Veling
authors.affiliation: Department of Early Psychosis,Dijk en Duin Psychiatric Institute,Castricum,The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Rietdijk
authors.affiliation: Department of Psychiatry,Academic Medical Center,Amsterdam,The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Dragt
authors.affiliation: Department of Child and Adolescent Psychiatry,GGZ Rivierduinen,Leiden,The Netherlands.
authors.forename: R M C
authors.initials: RM
authors.lastname: Klaassen
authors.affiliation: Department of Psychosis Research,Parnassia Psychiatric Institute,The Hague,The Netherlands.
authors.forename: N S P
authors.initials: NS
authors.lastname: Savelsberg
authors.affiliation: Department of Research and Education,Friesland Mental Health Services,Leeuwarden,The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Boonstra
authors.affiliation: Department of Psychiatry,Academic Medical Center,Amsterdam,The Netherlands.
authors.forename: D H
authors.initials: DH
authors.lastname: Nieman
authors.affiliation: Department of Psychiatry,Academic Medical Center,Amsterdam,The Netherlands.
authors.forename: D H
authors.initials: DH
authors.lastname: Linszen
authors.affiliation: Department of Research and Education,Friesland Mental Health Services,Leeuwarden,The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Wunderink
authors.affiliation: Department of Psychosis Research,Parnassia Psychiatric Institute,The Hague,The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van der Gaag
mesh_terms: D000293:Adolescent; D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000191:economics*; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011618:Psychotic Disorders / Q000191:economics* / Q000517:prevention & control*; D019057:Quality-Adjusted Life Years; D012306:Risk; D055815:Young Adult
keywords: ultra-high-risk patients