Sediqzadah Saadia, Portnoy Allison, Kim Jane J, Keshavan Matcheri, Pandya Ankur
Department of Psychiatry and Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Department of Psychiatry, University of Toronto, Toronto (Sediqzadah); Center for Health Decision Science, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston (Portnoy, Kim, Pandya); Massachusetts Mental Health Center and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (Keshavan).
Psychiatr Serv. 2022 Sep 1;73(9):970-977. doi: 10.1176/appi.ps.202100161. Epub 2022 Feb 23.
Programs for early intervention in psychosis have shown clinical efficacy. The authors aimed to evaluate the cost-effectiveness of early intervention programs compared with standard care for the treatment of first-episode psychosis in the United States.
A decision-analytic model integrating published data on clinical efficacy, costs, and health utilities was developed to evaluate early intervention versus standard care over the lifetime of patients after their first psychotic episode. Model input data were derived from meta-analyses, clinical trials, and U.S. national data. The main outcomes included hospitalizations, employment rate, quality-adjusted life years (QALYs), lifetime health care costs, and incremental cost-effectiveness ratios (ICERs).
Compared with patients receiving standard care, patients in the early intervention strategy had 3.2 fewer hospitalizations and 2.7 more years of employment over the course of their remaining life expectancy. From a health care perspective, early intervention had an ICER of approximately $51,600 per QALY. From a societal perspective, early intervention saved costs (i.e., yielded greater health benefits and had lower costs compared with standard care). Results were sensitive to the effect of early intervention on suicide, cost of standard care, cost of early intervention, and the effect (relative risk) of early intervention on employment. A scenario analysis that excluded the effect (i.e., hazard ratio) of early intervention on suicide yielded an ICER of approximately $197,000 per QALY.
These results suggest that it is economically beneficial to fund early intervention in psychosis programs in the United States. The findings indicate that early intervention in psychosis saves costs (from the societal perspective) and is cost-effective (health care sector perspective).
精神病早期干预项目已显示出临床疗效。作者旨在评估在美国，与标准治疗相比，早期干预项目治疗首发精神病的成本效益。
开发了一个决策分析模型，整合已发表的关于临床疗效、成本和健康效用的数据，以评估在患者首次精神病发作后的一生中，早期干预与标准治疗的效果。模型输入数据来自荟萃分析、临床试验和美国国家数据。主要结果包括住院次数、就业率、质量调整生命年（QALY）、终身医疗保健成本和增量成本效益比（ICER）。
与接受标准治疗的患者相比，采用早期干预策略的患者在剩余预期寿命期间住院次数少3.2次，就业年限多2.7年。从医疗保健角度看，早期干预的ICER约为每QALY 51,600美元。从社会角度看，早期干预节省了成本（即与标准治疗相比，产生了更大的健康效益且成本更低）。结果对早期干预对自杀的影响、标准治疗成本、早期干预成本以及早期干预对就业的影响（相对风险）敏感。一项排除早期干预对自杀影响（即风险比）的情景分析得出的ICER约为每QALY 197,000美元。
这些结果表明，在美国为精神病早期干预项目提供资金在经济上是有益的。研究结果表明，精神病早期干预节省了成本（从社会角度）且具有成本效益（从医疗保健部门角度）。
