Clinical Research Fellow, Dublin and East Treatment and Early Care Team (DETECT); and Clinical Research Fellow, School of Medicine, University College Dublin, Ireland.
Lecturer and Programme Director (Health Economics MSc), Department of Economics, National University of Ireland Galway, Ireland.
Br J Psychiatry. 2020 Sep;217(3):484-490. doi: 10.1192/bjp.2019.126.
Early intervention in psychosis is a complex intervention, usually delivered in a specialist stand-alone setting, which aims to improve outcomes for people with psychosis. Previous studies have been criticised because the control used did not accurately reflect actual practice.
To evaluate the cost-effectiveness of early intervention by estimating the incremental net benefit (INB) of an early-intervention programme, delivered in a real-world setting. INB measures the difference in monetary terms between alternative interventions.
Two contemporaneous incidence-based cohorts presenting with first-episode psychosis, aged 18-65 years, were compared. Costs and outcomes were measured over 1 year. The main outcome was avoidance of a relapse that required admission to hospital or home-based treatment.
From the health sector perspective, the probability that early intervention was cost-effective was 0.77. The INB was €2465 per person (95% CI - €4418 to €9347) when society placed a value of €6000, the cost of an in-patient relapse, on preventing a relapse requiring admission or home care. Following adjustment, the probability that early intervention was cost-effective was 1, and the INB to the health sector was €3105 per person (95% CI -€8453 to €14 663). From a societal perspective, the adjusted probability that early intervention was cost-effective was 1, and the INB was €19 928 per person (95% CI - €2075 to €41 931).
Early intervention has a modest INB from the health sector perspective and a large INB from the societal perspective. The perspective chosen is critical when presenting results of an economic evaluation of a complex intervention.
早期精神病干预是一种复杂的干预措施，通常在专门的独立环境中进行，旨在改善精神病患者的预后。先前的研究受到了批评，因为所使用的对照并不能准确反映实际情况。
通过估计早期干预计划的增量净效益（INB）来评估早期干预的成本效益，该计划是在真实环境中进行的。INB 以货币形式衡量替代干预措施之间的差异。
比较了两个同时发生的基于发病的队列，他们都患有首发精神病，年龄在 18-65 岁之间。在 1 年内测量成本和结果。主要结果是避免需要住院或家庭治疗的复发。
从卫生部门的角度来看，早期干预具有成本效益的概率为 0.77。当社会对预防住院或家庭护理所需的复发投入 6000 欧元的成本时，早期干预的增量净效益为每人 2465 欧元（95%CI-4418 至 9347 欧元）。调整后，早期干预具有成本效益的概率为 1，卫生部门的增量净效益为每人 3105 欧元（95%CI-8453 至 14663 欧元）。从社会角度来看，调整后的早期干预具有成本效益的概率为 1，增量净效益为每人 19928 欧元（95%CI-2075 至 41931 欧元）。
从卫生部门的角度来看，早期干预具有适度的增量净效益，从社会角度来看，具有较大的增量净效益。当呈现复杂干预的经济评估结果时，所选择的角度至关重要。
