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Economic impact of early intervention in people at high risk of psychosis

Published online by Cambridge University Press:  09 April 2009

L. R. Valmaggia ,
P. McCrone ,
M. Knapp ,
J. B. Woolley ,
M. R. Broome ,
P. Tabraham ,
L. C. Johns ,
C. Prescott ,
E. Bramon  and
J. Lappin
...Show all authors
L. R. Valmaggia*
Affiliation:
OASIS and Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK Department of Psychiatry and Neuropsychology, Maastricht University, The Netherlands
P. McCrone
Affiliation:
Centre for the Economics of Mental Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK
M. Knapp
Affiliation:
Centre for the Economics of Mental Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK Personal Social Services Research Unit, London School of Economics, UK
J. B. Woolley
Affiliation:
OASIS and Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK
M. R. Broome
Affiliation:
OASIS and Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK
P. Tabraham
Affiliation:
OASIS and Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK
L. C. Johns
Affiliation:
OASIS and Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK
C. Prescott
Affiliation:
OASIS and Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK
E. Bramon
Affiliation:
OASIS and Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK Lambeth Early Onset Service, South London and Maudsley Trust, UK
J. Lappin
Affiliation:
OASIS and Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK
P. Power
Affiliation:
Lambeth Early Onset Service, South London and Maudsley Trust, UK
P. K. McGuire
Affiliation:
OASIS and Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK
*
*Address for correspondence: L. R. Valmaggia, Ph.D., Department of Psychological Medicine and Psychiatry, PO 67, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. (Email: [email protected])
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Abstract

Background

Despite the increasing development of early intervention services for psychosis, little is known about their cost-effectiveness. We assessed the cost-effectiveness of Outreach and Support in South London (OASIS), a service for people with an at-risk mental state (ARMS) for psychosis.

Method

The costs of OASIS compared to care as usual (CAU) were entered in a decision model and examined for 12- and 24-month periods, using the duration of untreated psychosis (DUP) and rate of transition to psychosis as key parameters. The costs were calculated on the basis of services used following referral and the impact on employment. Sensitivity analysis was used to test the robustness of all the assumptions made in the model.

Results

Over the initial 12 months from presentation, the costs of the OASIS intervention were £1872 higher than CAU. However, after 24 months they were £961 less than CAU.

Conclusions

This model suggests that services that permit early detection of people at high risk of psychosis may be cost saving.

Keywords

At-risk mental statecost-effectivenessearly detectionearly interventionpsychosis
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 10 , October 2009 , pp. 1617 - 1626
Copyright
Copyright © Cambridge University Press 2009

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References

Andlin-Sobocki, P, Rössler, W (2005). Cost of psychotic disorders in Europe. European Journal of Neurology 12, s74–s77.CrossRefGoogle ScholarPubMed
Bentall, RP, Morrison, A (2002). More harm than good: the case against using anti-psychotic drugs to prevent severe mental illness. Journal of Mental Health 11, 351–356.CrossRefGoogle Scholar
Broome, MR, Woolley, JB, Johns, LC, Valmaggia, LR, Tabraham, P, Gafoor, R, Bramon, E, McGuire, PK (2005). Outreach and support in south London (OASIS): implementation of a clinical service for prodromal psychosis and the at risk mental state. European Psychiatry 20, 372–378.CrossRefGoogle ScholarPubMed
Cannon, TD, Cornblatt, B, McGorry, P (2007). The empirical status of the ultra high-risk (prodromal) research paradigm. Schizophrenia Bulletin 33, 661–664.CrossRefGoogle ScholarPubMed
Cornblatt, BA, Lencz, T, Smith, CW, Olsen, R, Auther, AM, Nakayama, E, Lesser, ML, Tai, JT, Shah, MR, Foley, CA, Kane, JM, Correll, CU (2007). Can antidepressants be used to treat the schizophrenia prodrome? Results of a prospective, naturalistic treatment study of adolescents. Journal of Clinical Psychiatry 68, 546–557.CrossRefGoogle ScholarPubMed
Correll, CU, Penzner, JB, Lencz, T, Auther, A, Smith, CW, Malhotra, AK, Kane, JM, Cornblatt, BA (2007). Early identification and high-risk strategies for bipolar disorder. Bipolar Disorders 9, 324–338.CrossRefGoogle ScholarPubMed
Craig, TKJ, Garety, P, Power, P, Rahaman, N, Colbert, S, Fornells-Ambrojo, M, Dunn, G (2004). The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis. British Medical Journal 329, 1067–1072.CrossRefGoogle ScholarPubMed
Curtis, L, Netten, A (2004). Unit Costs of Health and Social Care. University of Kent: Canterbury, Kent.Google Scholar
Department of Health (2001). The Mental Health Policy Implementation Guide. Department of Health: London.Google Scholar
Häfner, H, Maurer, K, Ruhrmann, S, Bechdolf, A, Klosterkötter, J, Wagner, M, Maier, W, Bottlender, R, Möller, HJ, Gaebel, W, Wölwer, W (2004). Early detection and secondary prevention of psychosis: facts and visions. European Archives of Psychiatry and Clinical Neuroscience 254, 117–128.CrossRefGoogle ScholarPubMed
Malla, AK, Norman, RM, Joober, R (2005). First-episode psychosis, early intervention, and outcome: what have we learned? Canadian Journal of Psychiatry 50, 881–891.CrossRefGoogle ScholarPubMed
Marshall, M, Lewis, S, Lockwood, A, Drake, R, Jones, P, Croudace, T (2005). Association between duration of untreated psychosis and outcome in cohorts of first episode psychosis. Archives of General Psychiatry 62, 975–983.CrossRefGoogle Scholar
McCrone, P, Jacobson, B (2004). Indicators of mental health activity in London: adjusting for sociodemographic need (http://www.lho.org.uk/Download/Public/8715/1/Mental_Health_Indicators_Final_Report_3.pdf) Accessed 18 March 2009.Google Scholar
McCrone, P (2007). Health economic measures in schizophrenia research. British Journal of Psychiatry 191, s42–s45.CrossRefGoogle Scholar
McGlashan, TH, Zipursky, RB, Perkins, D, Addington, J, Miller, T, Woods, SW, Hawkins, KA, Hoffman, RE, Preda, A, Epstein, I, Addington, D, Lindborg, S, Trzaskoma, Q, Tohen, M, Breier, A (2006). Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis. American Journal of Psychiatry 163, 790–799.CrossRefGoogle ScholarPubMed
McGorry, PD, Yung, AR, Phillips, LJ, Yuen, HP, Francey, S, Cosgrave, EM, Germano, D, Bravin, J, McDonald, T, Blair, A, Adlard, S, Jackson, H (2002). Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms. Archives of General Psychiatry 59, 921–928.CrossRefGoogle Scholar
McGuire, PK (2002). Prodromal intervention: the need for evaluation. Journal of Mental Health 11, 469–470.CrossRefGoogle Scholar
Mihalopoulos, C, McGorry, PD, Carter, RC (1999). Is phase-specific, community-oriented treatment of early psychosis an economically viable method of improving outcome? Acta Psychiatrica Scandinavica 100, 47–55.CrossRefGoogle ScholarPubMed
Miller, TJ, McGlashan, TH, Rosen, JL, Somjee, L, Markovich, PJ, Stein, K, Woods, SW (2002). Prospective diagnosis of the initial prodrome for schizophrenia based on the structured interview for prodromal syndromes: preliminary evidence of interrater reliability and predictive validity. American Journal of Psychiatry 159, 863–865.CrossRefGoogle ScholarPubMed
Morgan, C, Mallett, R, Hutchinson, G, Bagalote, H, Morgan, K, Fearon, P, Dazzan, P, Boydell, J, McKenzie, K, Harrison, G, Murray, R, Jones, P, Craig, T, Leff, J; AESOP Study Group (2005). Pathways to care and ethnicity. 1: Sample characteristics and compulsory admission. Report from the AESOP study. British Journal of Psychiatry 186, 281–289.CrossRefGoogle ScholarPubMed
Morrison, AP, French, P, Parker, S, Roberts, M, Stevens, H, Bentall, RP, Lewis, SW (2007). Three-year follow-up of a randomized controlled trial of cognitive therapy for the prevention of psychosis in people at ultrahigh risk. Schizophrenia Bulletin 33, 682–687.CrossRefGoogle ScholarPubMed
Morrison, AP, French, P, Walford, L, Lewis, SW, Kilcommons, A, Green, J, Parker, S, Bentall, RP (2004). Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomized controlled trial. British Journal of Psychiatry 185, 291–297.CrossRefGoogle Scholar
Netten, A, Curtis, L (2002). Unit Costs of Health and Social Care. PSSRU: Canterbury.Google Scholar
Office for National Statistics (2004). Annual survey of hours and earnings (ASHE) – 2004 results (including supplementary information) (http://www.statistics.gov.uk/statbase/Product.asp?vlnk=13290). Accessed 18 March 2009.Google Scholar
Office for National Statistics (2009). NOMIS official labour market statistics (https://www.nomisweb.co.uk/). Accessed 18 March 2009.Google Scholar
Phillips, LJ, Yung, AR, McGorry, PD (2000). Identification of young people at risk of psychosis: validation of personal assessment and crisis evaluation clinic intake criteria. Australian and New Zealand Journal of Psychiatry 34, S164–S169.CrossRefGoogle ScholarPubMed
Phillips, LJ, McGorry, PD, Pan Yuen, H, Ward, J, Donovan, K, Kelly, D, Francey, SM, Yung, AR (2007). Medium term follow-up of a randomized controlled trial of interventions for young people at ultra high risk of psychosis. Schizophrenia Research 96, 25–33.CrossRefGoogle ScholarPubMed
Power, P, McGuire, P, Iacoponi, E, Garety, P, Morris, E, Valmaggia, LR, Grafton, D, Craig, T (2009). Lambeth Early Onset (LEO) and Outreach and Support in South London (OASIS) Service. Early Intervention in Psychiatry 1, 97–103.CrossRefGoogle Scholar
Treeage Software Inc. (2002). Data 4.0. Treeage Software Inc.: Williamstown, MA.Google Scholar
Warner, R (2005). Problems with early and very early intervention in psychosis. British Journal of Psychiatry 187, s104–s107.CrossRefGoogle Scholar
Yung, AR, Phillips, LJ, McGorry, PD, McFarlane, CA, Francey, S, Harrigan, S, Patton, GC, Jackson, HJ (1998). Prediction of psychosis. A step towards indicated prevention in schizophrenia. British Journal of Psychiatry 172, 14–20.CrossRefGoogle ScholarPubMed
Yung, AR, Phillips, LJ, Yuen, HP, Francey, SM, McFarlane, CA, Hallgren, M, McGorry, PD (2003). Psychosis prediction: 12-month follow-up of a high-risk (‘prodromal’) group. Schizophrenia Research 60, 21–32.CrossRefGoogle ScholarPubMed
Yung, AR, Phillips, LJ, Yuen, HP, McGorry, PD (2004). Risk factors for psychosis in an ultra high-risk group: psychopathology and clinical features. Schizophrenia Research 67, 131–142.CrossRefGoogle Scholar