Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam Road, Hong Kong.
Aust N Z J Psychiatry. 2011 Aug;45(8):673-80. doi: 10.3109/00048674.2011.586329.
The Early Assessment Service for Young People with Early Psychosis (EASY) was developed in Hong Kong in 2001 to provide a comprehensive and integrated approach for early detection and intervention for young people suffering from first episode psychosis. The present study examined the cost-effectiveness of the service over a period of 24 months compared to standard care.
This is a historical control study. Sixty-five patients who presented to the EASY service in 2001 with first episode psychosis were individually matched (on age, sex and diagnosis) with 65 patients who received standard psychiatric care in a precursor service (pre-EASY) between 1999 and 2000. A retrospective cost-effectiveness analysis was conducted over a period of 24 months. The overall average cost of service utilization per patient and the effects on hospitalization rate were compared using bootstrapping analysis. Cost per point improvement in Positive and Negative Syndrome Scale (PANSS) was also computed with sensitivity analysis. Only direct costs were analysed in the current study.
There was no significant difference in service utilization between the EASY and pre-EASY standard care groups. The cost-effectiveness acceptability curve, which was used to explore uncertainty in estimates of cost and effects, suggested that there was a probability of at least 94% that the EASY model was more cost-effective than the pre-EASY service in reducing psychiatric inpatient admissions. EASY patients also showed superior results in average cost per unit improvement in PANSS.
EASY is likely to be more cost-effective in improving outcomes, particularly in reducing hospitalization and improving clinical symptoms among young people with first episode psychosis. This study provides a perspective from the east Asian region, and supports further development of similar services, particularly in the local setting. However, further studies with a longer follow up period and larger sample size are required to verify these findings.
早发性精神障碍青年早期评估服务（EASY）于 2001 年在香港成立，旨在为首发精神障碍的年轻人提供全面综合的早期检测和干预措施。本研究在 24 个月的时间内，将该服务与标准护理进行了成本效益比较。
这是一项历史性对照研究。2001 年，65 名首次出现精神病症状的患者来到 EASY 服务中心，与 1999 年至 2000 年间在前身服务（EASY 前）接受标准精神科护理的 65 名患者进行了个体匹配（年龄、性别和诊断）。进行了为期 24 个月的回顾性成本效益分析。采用 bootstrap 分析比较了每位患者的服务利用总成本和住院率的影响。还通过敏感性分析计算了阳性和阴性症状量表（PANSS）评分每提高一点的成本。本研究仅分析了直接成本。
EASY 组和 EASY 前标准护理组的服务利用没有显著差异。成本效益接受性曲线用于探索成本和效果估计的不确定性，该曲线表明，EASY 模式在降低精神科住院率方面比 EASY 前服务更具成本效益的可能性至少为 94%。EASY 组患者在 PANSS 平均单位改善的成本方面也表现出更好的结果。
EASY 可能在改善结果方面更具成本效益，特别是在减少首发精神障碍年轻人的住院率和改善临床症状方面。本研究提供了东亚地区的视角，并支持在当地环境中进一步开发类似的服务。然而，需要进一步开展随访时间更长、样本量更大的研究来验证这些发现。
