title: Cost-Effectiveness of Comprehensive, Integrated Care for First Episode Psychosis in the NIMH RAISE Early Treatment Program.
abstract: This study compares the cost-effectiveness of Navigate (NAV), a comprehensive, multidisciplinary, team-based treatment approach for first episode psychosis (FEP) and usual Community Care (CC) in a cluster randomization trial. Patients at 34 community treatment clinics were randomly assigned to either NAV (N = 223) or CC (N = 181) for 2 years. Effectiveness was measured as a one standard deviation change on the Quality of Life Scale (QLS-SD). Incremental cost effectiveness ratios were evaluated with bootstrap distributions. The Net Health Benefits Approach was used to evaluate the probability that the value of NAV benefits exceeded its costs relative to CC from the perspective of the health care system. The NAV group improved significantly more on the QLS and had higher outpatient mental health and antipsychotic medication costs. The incremental cost-effectiveness ratio was $12 081/QLS-SD, with a .94 probability that NAV was more cost-effective than CC at $40 000/QLS-SD. When converted to monetized Quality Adjusted Life Years, NAV benefits exceeded costs, especially at future generic drug prices.
authors.affiliation: Department of Psychiatry and Public Health, Yale Medical School, New Haven, CT; Robert.Rosenheck@Yale.Edu.
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenheck
authors.affiliation: Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA;
authors.forename: Douglas
authors.initials: D
authors.lastname: Leslie
authors.affiliation: Department of Psychiatry and Public Health, Yale Medical School, New Haven, CT;
authors.forename: Kyaw
authors.initials: K
authors.lastname: Sint
authors.affiliation: Department of Psychiatry and Public Health, Yale Medical School, New Haven, CT;
authors.forename: Haiqun
authors.initials: H
authors.lastname: Lin
authors.forename: Delbert G
authors.initials: DG
authors.lastname: Robinson
authors.affiliation: Psychiatry Research, Zucker Hillside Hospital, North Shore-Long Island Jewish, Glen Oaks, NY; Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY; Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY;
authors.forename: Nina R
authors.initials: NR
authors.lastname: Schooler
authors.affiliation: Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychiatry, and Psychology, Boston University, Boston, MA;
authors.forename: Kim T
authors.initials: KT
authors.lastname: Mueser
authors.affiliation: Department of Psychology, University of North Carolina-Chapel Hill, Chapel Hill, NC; School of Psychology, Australian Catholic University, Melbourne, Australia;
authors.forename: David L
authors.initials: DL
authors.lastname: Penn
authors.affiliation: Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Canada;
authors.forename: Jean
authors.initials: J
authors.lastname: Addington
authors.affiliation: Geisel School of Medicine at Dartmouth, Lebanon, NH; Bureau of Behavioral Health, DHHS, Concord, NH;
authors.forename: Mary F
authors.initials: MF
authors.lastname: Brunette
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
authors.affiliation: Department of Social Medicine, University of North Carolina, Chapel Hill, NC;
authors.forename: Sue E
authors.initials: SE
authors.lastname: Estroff
authors.affiliation: Psychiatry Research, Zucker Hillside Hospital, North Shore-Long Island Jewish, Glen Oaks, NY;
authors.forename: Patricia
authors.initials: P
authors.lastname: Marcy
authors.affiliation: Nathan Kline Institute, Orangeburg, NY;
authors.forename: James
authors.initials: J
authors.lastname: Robinson
authors.affiliation: National Institute of Mental Health, Rockville, MD.
authors.forename: Joanne
authors.initials: J
authors.lastname: Severe
authors.affiliation: National Institute of Mental Health, Rockville, MD.
authors.forename: Agnes
authors.initials: A
authors.lastname: Rupp
authors.affiliation: National Institute of Mental Health, Rockville, MD.
authors.forename: Michael
authors.initials: M
authors.lastname: Schoenbaum
authors.forename: John M
authors.initials: JM
authors.lastname: Kane
mesh_terms: D000293:Adolescent; D000328:Adult; D003156:Community Mental Health Services / Q000191:economics / Q000592:standards*; D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000592:standards*; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D009315:National Institute of Mental Health (U.S.); D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000191:economics / Q000592:standards*; D011618:Psychotic Disorders / Q000191:economics / Q000628:therapy*; D012559:Schizophrenia / Q000191:economics / Q000628:therapy*; D014481:United States; D055815:Young Adult
keywords: cost-effectiveness; quality adjusted life years; schizophrenia
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