Department of Medicine, University of Queensland, Brisbane, Australia.
Aust N Z J Psychiatry. 2012 Aug;46(8):719-34. doi: 10.1177/0004867412450470. Epub 2012 Jun 13.
Early-intervention units have proliferated over the last decade, justified in terms of cost as well as treatment effect. Strong claims for extension of these programmes on economic grounds motivate a systematic review of economic evaluations of early-intervention programmes.
Searches were undertaken in the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and PsycINFO with keywords including 'early intervention', 'ultra-high risk', 'prodrome', 'cost-effectiveness', 'psychosis', 'economic', and 'at-risk mental state'. Relevant journals, editorials, and the references of retrieved articles were hand-searched for appropriate research.
Eleven articles were included in the review. The more rigorous research (two randomized control trials and two quasi-experimental studies) suggested no difference in resource utilization or costs between early-intervention and treatment-as-usual groups. One small case-control study with evidence of significant bias concluded annual early-intervention costs were one-third of treatment-as-usual costs. Modelling studies projected reduced costs of early intervention but were based on assumptions since definitively revised. Cost-effectiveness analyses did not strongly support the cost-effectiveness of early intervention. No studies appropriately valued outpatient costs or addressed the feasibility of realizing reduced hospitalization in reduced costs.
The published literature does not support the contention that early intervention for psychosis reduces costs or achieves cost-effectiveness. Past failed attempts to reduce health costs by reducing hospitalization, and increased outpatient costs in early-intervention programmes suggest such programmes may increase costs. Future economic evaluation of early-intervention programmes would need to correctly value outpatient costs and accommodate uncertainty regarding reduced hospitalization costs, perhaps by sensitivity analysis. The current research hints that cost differences may be greater early in treatment and in patients with more severe illness.
在过去的十年中，早期干预单位如雨后春笋般涌现，其合理性不仅在于成本，还在于治疗效果。基于经济原因，强烈要求将这些方案扩展到这些方案，这促使我们对早期干预方案的经济评估进行系统审查。
使用 Cochrane 中央对照试验注册库、PubMed、EMBASE 和 PsycINFO 进行了搜索，关键词包括“早期干预”、“超高风险”、“前驱期”、“成本效益”、“精神病”、“经济”和“处于危险中的精神状态”。检索到的文章的相关期刊、社论和参考文献也进行了手工搜索，以寻找合适的研究。
综述共纳入 11 篇文章。更严格的研究（两项随机对照试验和两项准实验研究）表明，早期干预组和常规治疗组在资源利用或成本方面没有差异。一项小型病例对照研究存在明显偏倚的证据，得出的结论是，早期干预的年度成本是常规治疗成本的三分之一。建模研究预测早期干预的成本降低，但这些预测是基于假设，而这些假设已经被修正。成本效益分析并没有强有力地支持早期干预的成本效益。没有研究恰当地评估门诊费用，也没有解决在降低成本的情况下实现减少住院治疗的可行性。
已发表的文献并不支持早期干预精神病可降低成本或具有成本效益的观点。过去通过减少住院治疗来降低医疗成本以及增加早期干预计划的门诊费用的尝试均以失败告终，这表明此类方案可能会增加成本。未来对早期干预计划的经济评估需要正确评估门诊费用，并考虑减少住院费用的不确定性，或许可以通过敏感性分析来解决。目前的研究表明，成本差异在治疗早期和病情更严重的患者中可能更大。
