The cost effectiveness of early intervention for psychosis: a report by Access Economics

Access Economics was asked by the Orygen Research Centre to compare the cost effectiveness of providing either early intervention or treatment as usual to individuals who experience a first episode of psychosis. Access Economics defined ‘early intervention treatment’ (EI) as: …“the use of low-dose atypical medications, cognitive behavioural therapy, family interventions, vocational recovery programs, continuing care programs that focus on relapse prevention…(and)…substance misuse interventions”. Access Economics also defined ‘treatment as usual’ (TAU) as: …“the provision of high doses of antipsychotic medication, hospitalisation in all acute episodes…(and an)…absence of structured interventions.”

 

 

Taking data from trials that investigated the comparative cost of providing interventions in first episode psychosis versus treatment as usual (at the Early Psychosis Prevention and Intervention Centre, a Swedish trial and two trials in the UK), Access Economics reported that: …”because EI trials cost less than TAU trials ($6,805 against $8,796), and result in a lower burden of disease…in terms of incremental cost effectiveness, EI dominates TAU.”

 

Yet, up to five years after the first episode, the evidence for EI continuing to be more cost effective than TAU is not as substantial as the evidence for positive cost effectiveness at first onset: “While the EPPIC trial reports continual cost savings six years or more after the intervention program was completed, the Danish OPUS trial…reported most EI benefits were no longer evident three years after the intervention finished. Hence, Access Economics does not consider there is sufficient evidence to protect benefits beyond the “critical period” of five years after the first psychotic episode.”

 

Based on Australian Institute of Health and Welfare figures, Access Economics estimated there will be some 5,320 FEP new incidences per year in Australia. In simple terms, each year over 5000 young people will become affected by a potentially life-threatening condition that is treatable with proper early intervention. Access Economics concluded: “For this cohort, if EI was universally available…the net present value of savings over the critical period would be $212.5 million ($82.5 million in financial savings and $130 million in reduced burden of disease).”