PhD Candidate, Health Service and Population Research Department,Institute of Psychiatry,Psychology and Neuroscience, King's College London,UK; andPsychiatry Department, School of Medicine, Pontificia Universidad Católica de Chile,Chile.
PhD Candidate, Health Service and Population Research Department,Institute of Psychiatry, Psychology and Neuroscience,King's College London,UK.
Br J Psychiatry. 2019 Jul;215(1):388-394. doi: 10.1192/bjp.2018.298. Epub 2019 Jan 30.
Early intervention in psychosis (EIP) has been developed as an approach to improve the prognosis of people with psychotic disorders and it has been claimed to be a more efficient model of care. However, the evidence is not definitive and doubts have spread regard to the economic outcomes of EIP services amid the usually restricted mental health budget.AimsWe aimed to review the cost-effectiveness evidence of EIP services worldwide.
We systematically reviewed the economic literature about EIP following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement guidelines. Studies were selected according to previously stated criteria and analysed with standardised critical appraisal tools for trial-based economic evaluations and modelling studies.
A total of 16 studies were selected after applying the eligibility criteria. Most of them were economic evaluations alongside clinical trials. The overall evidence was consistent in the cost-effectiveness of EIP compared with standard care for first episode of psychosis and the Clinical High Risk for Psychosis paradigm. Such evidence was replicated among different health systems, but mainly in high-income countries. The methodological quality of such evidence, however, was moderate and heterogeneity was significant across the studies.
There is consistent evidence that the implementation of EIP services might be a cost-effective alternative across different health systems. Such evidence, nevertheless, derives from heterogeneous and sometimes methodologically flawed studies, reducing the certainty of such statement. More efforts must be done to rigorously assess the value of this intervention, before expanding it among systems where mental health budgets are more constrained.Declaration of interestNone.
早期精神病干预（EIP）已被开发为一种改善精神病患者预后的方法，并且据称是一种更有效的护理模式。然而，证据并不明确，并且在精神卫生预算通常有限的情况下，人们对 EIP 服务的经济结果产生了怀疑。
我们旨在全球范围内审查 EIP 服务的成本效益证据。
我们按照系统评价和荟萃分析报告的首选项目声明指南，系统地审查了有关 EIP 的经济文献。根据先前规定的标准选择了研究，并使用标准化的关键性评估工具对试验型经济评估和建模研究进行了分析。
在应用资格标准后，共选择了 16 项研究。其中大多数是与临床试验同时进行的经济评估。总体证据表明，EIP 与首发精神病和精神病高危临床风险范式的标准护理相比具有成本效益。这种证据在不同的卫生系统中得到了复制，但主要是在高收入国家。然而，这种证据的方法学质量中等，并且研究之间存在显著的异质性。
有一致的证据表明，在不同的卫生系统中实施 EIP 服务可能是一种具有成本效益的替代方案。然而，这种证据来自异质的、有时方法上有缺陷的研究，降低了这种说法的确定性。在扩大到精神卫生预算更为有限的系统之前，必须更加努力严格评估这种干预的价值。
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