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Cost-effectiveness of preventing first-episode psychosis in ultra-high-risk subjects: multi-centre randomized controlled trial

Published online by Cambridge University Press:  21 October 2014

H. K. Ising ,
F. Smit ,
W. Veling ,
J. Rietdijk ,
S. Dragt ,
R. M. C. Klaassen ,
N. S. P. Savelsberg ,
N. Boonstra ,
D. H. Nieman  and
D. H. Linszen
...Show all authors
H. K. Ising
Affiliation:
Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands
F. Smit
Affiliation:
Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands Department of Public Mental Health, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
W. Veling
Affiliation:
Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
J. Rietdijk
Affiliation:
Department of Early Psychosis, Dijk en Duin Psychiatric Institute, Castricum, The Netherlands
S. Dragt
Affiliation:
Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
R. M. C. Klaassen
Affiliation:
Department of Child and Adolescent Psychiatry, GGZ Rivierduinen, Leiden, The Netherlands
N. S. P. Savelsberg
Affiliation:
Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
N. Boonstra
Affiliation:
Department of Research and Education, Friesland Mental Health Services, Leeuwarden, The Netherlands
D. H. Nieman
Affiliation:
Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
D. H. Linszen
Affiliation:
Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
L. Wunderink
Affiliation:
Department of Research and Education, Friesland Mental Health Services, Leeuwarden, The Netherlands
M. van der Gaag*
Affiliation:
Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
*
*Address for correspondence: M. van der Gaag, Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. (Email: [email protected])
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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.

Method

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.

Keywords

Preventionpsychosisquality-adjusted life yearsultra-high-risk patients
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 7 , May 2015 , pp. 1435 - 1446
Copyright
Copyright © Cambridge University Press 2014 

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