A review of economic evaluations of health care for people at risk of psychosis and for first-episode psychosis

Gemma E Shields; Deborah Buck; Filippo Varese; Alison R Yung; Andrew Thompson; Nusrat Husain; Matthew R Broome; Rachel Upthegrove; Rory Byrne; Linda M Davies

doi:10.1186/s12888-022-03769-7

A review of economic evaluations of health care for people at risk of psychosis and for first-episode psychosis

BMC Psychiatry. 2022 Feb 17;22(1):126. doi: 10.1186/s12888-022-03769-7.

Authors

Gemma E Shields¹, Deborah Buck^{2

3}, Filippo Varese^{4

5}, Alison R Yung^{4

5

6

7}, Andrew Thompson^{8

9}, Nusrat Husain⁴, Matthew R Broome^{10

11}, Rachel Upthegrove^{10

11}, Rory Byrne⁵, Linda M Davies²

Affiliations

¹ Manchester Centre for Health Economics, Division of Population Health, School of Health Sciences, University of Manchester, Manchester, UK. gemma.shields@manchester.ac.uk.
² Manchester Centre for Health Economics, Division of Population Health, School of Health Sciences, University of Manchester, Manchester, UK.
³ Institute of Education, University College London, London, UK.
⁴ Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK.
⁵ Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
⁶ Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
⁷ Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia.
⁸ Orygen, The Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia.
⁹ Division of Mental Health and Wellbeing, University of Warwick, Coventry, UK.
¹⁰ Institute for Mental Health, University of Birmingham, Birmingham, UK.
¹¹ Birmingham Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.

Abstract

Background: Preventing psychotic disorders and effective treatment in first-episode psychosis are key priorities for the National Institute for Health and Care Excellence. This review assessed the evidence base for the cost-effectiveness of health and social care interventions for people at risk of psychosis and for first-episode psychosis.

Methods: Electronic searches were conducted using the PsycINFO, MEDLINE and Embase databases to identify relevant published full economic evaluations published before August 2020. Full-text English-language studies reporting a full economic evaluation of a health or social care intervention aiming to reduce or prevent symptoms in people at risk of psychosis or experiencing first-episode psychosis were included. Screening, data extraction, and critical appraisal were performed using pre-specified criteria and forms based on the NHS Economic Evaluation Database (EED) handbook and Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist for economic evaluations. The protocol was registered on the PROSPERO database (CRD42018108226). Results were summarised qualitatively.

Results: Searching identified 1,628 citations (1,326 following the removal of duplications). After two stages of screening 14 studies met the inclusion criteria and were included in the review. Interventions were varied and included multidisciplinary care, antipsychotic medication, psychological therapy, and assertive outreach. Evidence was limited in the at-risk group with only four identified studies, though all interventions were found to be cost-effective with a high probability (> 80%). A more substantial evidence base was identified for first-episode psychosis (11 studies), with a focus on early intervention (7/11 studies) which again had positive conclusions though with greater uncertainty.

Conclusions: Study findings generally concluded interventions were cost-effective. The evidence for the population who are at-risk of psychosis was limited, and though there were more studies for the population with first-episode psychosis, limitations of the evidence base (including generalisability and heterogeneity across the methods used) affect the certainty of conclusions.

Keywords: Cost-effectiveness; Cost-utility; Economic evaluation; Psychosis; Systematic review.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Antipsychotic Agents*
Cost-Benefit Analysis
Delivery of Health Care
Humans
Psychotic Disorders* / therapy
Treatment Outcome

Substances

Antipsychotic Agents