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Cost-effectiveness of preventing first-episode psychosis in ultra-high-risk subjects: multi-centre randomized controlled trial

Published online by Cambridge University Press:  21 October 2014

H. K. Ising ,
F. Smit ,
W. Veling ,
J. Rietdijk ,
S. Dragt ,
R. M. C. Klaassen ,
N. S. P. Savelsberg ,
N. Boonstra ,
D. H. Nieman  and
D. H. Linszen
...Show all authors
H. K. Ising
Affiliation:
Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands
F. Smit
Affiliation:
Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands Department of Public Mental Health, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
W. Veling
Affiliation:
Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
J. Rietdijk
Affiliation:
Department of Early Psychosis, Dijk en Duin Psychiatric Institute, Castricum, The Netherlands
S. Dragt
Affiliation:
Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
R. M. C. Klaassen
Affiliation:
Department of Child and Adolescent Psychiatry, GGZ Rivierduinen, Leiden, The Netherlands
N. S. P. Savelsberg
Affiliation:
Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
N. Boonstra
Affiliation:
Department of Research and Education, Friesland Mental Health Services, Leeuwarden, The Netherlands
D. H. Nieman
Affiliation:
Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
D. H. Linszen
Affiliation:
Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
L. Wunderink
Affiliation:
Department of Research and Education, Friesland Mental Health Services, Leeuwarden, The Netherlands
M. van der Gaag*
Affiliation:
Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
*
*Address for correspondence: M. van der Gaag, Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. (Email: [email protected])
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Abstract

Background

Although there is evidence for the effectiveness of interventions for psychosis among ultra-high-risk (UHR) groups, health economic evaluations are lacking. This study aimed to determine the cost effectiveness and cost–utility of cognitive–behavioural therapy (CBT) to prevent first-episode psychosis.

Method

The Dutch Early Detection and Intervention Evaluation study was a randomized controlled trial of 196 UHR patients with an 18-month follow-up. All participants were treated with routine care (RC) for non-psychotic disorders. The experimental group (n = 95) received add-on CBT to prevent first-episode psychosis. We report the intervention, medical and travel costs, as well as costs arising from loss of productivity. Treatment response was defined as psychosis-free survival and quality-adjusted life years (QALYs) gained.

Results

In the cost-effectiveness analysis, the proportion of averted psychoses was significantly higher in the CBT condition (89.5% v. 76.2%). CBT showed a 63.7% probability of being more cost effective, because it was less costly than RC by US$844 (£551) per prevented psychosis. In the cost–utility analysis, QALY health gains were slightly higher for CBT than for RC (0.60 v. 0.57) and the CBT intervention had a 52.3% probability of being the superior treatment because, for equal or better QALY gains, the costs of CBT were lower than those of RC.

Conclusions

Add-on preventive CBT for UHR resulted in a significant reduction in the incidence of first psychosis. QALY gains show little difference between the two conditions. The CBT intervention proved to be cost saving.

Keywords

Preventionpsychosisquality-adjusted life yearsultra-high-risk patients
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 7 , May 2015 , pp. 1435 - 1446
Copyright
Copyright © Cambridge University Press 2014 

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References

Addington, D, Addington, J, Maticka-Tyndale, E, Joyce, J (1992). Reliability and validity of a depression rating scale for schizophrenics. Schizophrenia Research 6, 201–208.Google Scholar
Beck, A, Steer, R, Brown, G (1996). Manual for Beck Depression Inventory-II. Psychological Corporation: San Antonio, TX.Google Scholar
Birchwood, M, Jackson, C, Brunet, K, Holden, J, Barton, K (2012). Personal Beliefs about Illness Questionnaire-Revised (PBIQ-R): reliability and validation in a first episode sample. British Journal of Clinical Psychology 51, 448–458.CrossRefGoogle Scholar
Briggs, A (2000). Economic evaluation and clinical trials: size matters. British Medical Journal 321, 1362–1363.CrossRefGoogle ScholarPubMed
Brooks, R (1996). EuroQol: the current state of play. Health Policy 37, 53–72.Google Scholar
Carr, VJ, Neil, AL, Halpin, SA, Holmes, S, Lewin, TJ (2003). Costs of schizophrenia and other psychoses in urban Australia: findings from the Low Prevalence (Psychotic) Disorders Study. Australian and New Zealand Journal of Psychiatry 37, 31–40.Google Scholar
Dolan, P (1997). Modeling valuations for EuroQol health states. Medical Care 35, 1095–1108.Google Scholar
Drummond, MF, Sculpher, MJ, Torrance, GW, O'Brien, BJ, Stoddart, GL (2005). Methods for the Economic Evaluation of Health Care Programmes. Oxford University Press: New York.Google Scholar
French, P, Morrison, AP (2004). Early Detection and Cognitive Therapy for People at High Risk of Developing Psychosis: A Treatment Approach. John Wiley: West Sussex.Google Scholar
Fusar-Poli, P, Bonoldi, I, Yung, AR, Borgwardt, S, Kempton, MJ, Valmaggia, L, Barale, F, Caverzasi, E, McGuire, P (2012). Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Archives of General Psychiatry 69, 220–229.Google Scholar
Fusar-Poli, P, Borgwardt, S, Bechdolf, A, Addington, J, Riecher-Rössler, A, Schultze-Lutter, F, Keshavan, M, Wood, S, Ruhrmann, S, Seidman, LJ, Valmaggia, L, Cannon, T, Velthorst, E, De Haan, L, Cornblatt, B, Bonoldi, I, Birchwood, M, McGlashan, T, Carpenter, W, McGorry, P, Klosterkötter, J, McGuire, P, Yung, A (2013). The psychosis high-risk state: a comprehensive state-of-the-art review. JAMA Psychiatry 70, 107–120.CrossRefGoogle Scholar
Goldman, HH, Skodol, AE, Lave, TR (1992). Revising Axis V for DSM-IV: a review of measures of social functioning. American Journal of Psychiatry 149, 1148–1156.Google Scholar
Hakkaart-van Rooijen, L (2002). Manual Trimbos/iMTA Questionnaire for Costs Associated with Psychiatric Illness (in Dutch). Institute for Medical Technology Assessment, Erasmus University: Rotterdam, The Netherlands.Google Scholar
Hakkaart-van Rooijen, L, Tan, SS, Bouwmans, CAM (2010). Handleiding voor kostenonderzoek. Methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg (in Dutch). Institute for Medical Technology University Assessment, Erasmus University: Rotterdam, The Netherlands.Google Scholar
Hutton, P, Taylor, PJ (2013). Cognitive behavioural therapy for psychosis prevention: a systematic review and meta-analysis. Psychological Medicine 44, 449–468.Google Scholar
Ising, HK, Veling, W, Loewy, RL, Rietveld, MW, Rietdijk, J, Dragt, S, Klaassen, RMC, Nieman, DH, Wunderink, L, Linszen, DH, van der Gaag, M (2012). The validity of the 16-item version of the Prodromal Questionnaire (PQ-16) to screen for ultra high risk of developing psychosis in the general help-seeking population. Schizophrenia Bulletin 38, 1288–1296.Google Scholar
Landelijke Stuurgroep Multidisciplinaire Richtlijnontwikkeling in de GGZ (Dutch Committee for the Development of Multidisciplinary Guidelines in Mental Health) (2014). Homepage (http://www.ggzrichtlijnen.nl/). Accessed 14 August 2014.Google Scholar
Matthews, JN, Altman, DG, Campbell, MJ, Royston, P (1990). Analysis of serial measurements in medical research. British Medical Journal 300, 230–235.Google Scholar
Mattick, RP, Clarke, JC (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy 36, 455–470.Google Scholar
Mihalopoulos, C, Vos, T, Pirkis, J, Carter, R (2011). The economic analysis of prevention in mental health programs. Annual Review of Clinical Psychology 7, 169–201.CrossRefGoogle ScholarPubMed
Murray, CJL, Vos, T, Lozano, R, Naghavi, M, Flaxman, AD, Michaud, C, Ezzati, M, Shibuya, K, Salomon, JA, Abdalla, S, Aboyans, V, Abraham, J, Ackerman, I, Aggarwal, R, Ahn, SY, Ali, MK, Alvarado, M, Anderson, HR, Anderson, LM, Andrews, KG, Atkinson, C, Baddour, LM, Bahalim, AN, Barker-Collo, S, Barrero, LH, Bartels, DH, Basáñez, M-G, Baxter, A, Bell, ML, Benjamin, EJ, Bennett, D, Bernabé, E, Bhalla, K, Bhandari, B, Bikbov, B, Bin Abdulhak, A, Birbeck, G, Black, JA, Blencowe, H, Blore, JD, Blyth, F, Bolliger, I, Bonaventure, A, Boufous, S, Bourne, R, Boussinesq, M, Braithwaite, T, Brayne, C, Bridgett, L, Brooker, S, Brooks, P, Brugha, TS, Bryan-Hancock, C, Bucello, C, Buchbinder, R, Buckle, G, Budke, CM, Burch, M, Burney, P, Burstein, R, Calabria, B, Campbell, B, Canter, CE, Carabin, H, Carapetis, J, Carmona, L, Cella, C, Charlson, F, Chen, H, Cheng, AT-A, Chou, D, Chugh, SS, Coffeng, LE, Colan, SD, Colquhoun, S, Colson, KE, Condon, J, Connor, MD, Cooper, LT, Corriere, M, Cortinovis, M, de Vaccaro, KC, Couser, W, Cowie, BC, Criqui, MH, Cross, M, Dabhadkar, KC, Dahiya, M, Dahodwala, N, Damsere-Derry, J, Danaei, G, Davis, A, De Leo, D, Degenhardt, L, Dellavalle, R, Delossantos, A, Denenberg, J, Derrett, S, Des Jarlais, DC, Dharmaratne, SD, Dherani, M, Diaz-Torne, C, Dolk, H, Dorsey, ER, Driscoll, T, Duber, H, Ebel, B, Edmond, K, Elbaz, A, Ali, SE, Erskine, H, Erwin, PJ, Espindola, P, Ewoigbokhan, SE, Farzadfar, F, Feigin, V, Felson, DT, Ferrari, A, Ferri, CP, Fèvre, EM, Finucane, MM, Flaxman, S, Flood, L, Foreman, K, Forouzanfar, MH, Fowkes, FG, Fransen, M, Freeman, MK, Gabbe, BJ, Gabriel, SE, Gakidou, E, Ganatra, HA, Garcia, B, Gaspari, F, Gillum, RF, Gmel, G, Gonzalez-Medina, D, Gosselin, R, Grainger, R, Grant, B, Groeger, J, Guillemin, F, Gunnell, D, Gupta, R, Haagsma, J, Hagan, H, Halasa, YA, Hall, W, Haring, D, Haro, JM, Harrison, JE, Havmoeller, R, Hay, RJ, Higashi, H, Hill, C, Hoen, B, Hoffman, H, Hotez, PJ, Hoy, D, Huang, JJ, Ibeanusi, SE, Jacobsen, KH, James, SL, Jarvis, D, Jasrasaria, R, Jayaraman, S, Johns, N, Jonas, JB, Karthikeyan, G, Kassebaum, N, Kawakami, N, Keren, A, Khoo, JP, King, CH, Knowlton, LM, Kobusingye, O, Koranteng, A, Krishnamurthi, R, Laden, F, Lalloo, R, Laslett, LL, Lathlean, T, Leasher, JL, Lee, YY, Leigh, J, Levinson, D, Lim, SS, Limb, E, Lin, JK, Lipnick, M, Lipshultz, SE, Liu, W, Loane, M, Ohno, SL, Lyons, R, Mabweijano, J, MacIntyre, MF, Malekzadeh, R, Mallinger, L, Manivannan, S, Marcenes, W, March, L, Margolis, DJ, Marks, GB, Marks, R, Matsumori, A, Matzopoulos, R, Mayosi, BM, McAnulty, JH, McDermott, MM, McGill, N, McGrath, J, Medina-Mora, ME, Meltzer, M, Mensah, GA, Merriman, TR, Meyer, AC, Miglioli, V, Miller, M, Miller, TR, Mitchell, PB, Mock, C, Mocumbi, AO, Moffitt, TE, Mokdad, AA, Monasta, L, Montico, M, Moradi-Lakeh, M, Moran, A, Morawska, L, Mori, R, Murdoch, ME, Mwaniki, MK, Naidoo, K, Nair, MN, Naldi, L, Narayan, KM, Nelson, PK, Nelson, RG, Nevitt, MC, Newton, CR, Nolte, S, Norman, P, Norman, R, O'Donnell, M, O'Hanlon, S, Olives, C, Omer, SB, Ortblad, K, Osborne, R, Ozgediz, D, Page, A, Pahari, B, Pandian, JD, Rivero, AP, Patten, SB, Pearce, N, Padilla, RP, Perez-Ruiz, F, Perico, N, Pesudovs, K, Phillips, D, Phillips, MR, Pierce, K, Pion, S, Polanczyk, GV, Polinder, S, Pope, CA 3rd, Popova, S, Porrini, E, Pourmalek, F, Prince, M, Pullan, RL, Ramaiah, KD, Ranganathan, D, Razavi, H, Regan, M, Rehm, JT, Rein, DB, Remuzzi, G, Richardson, K, Rivara, FP, Roberts, T, Robinson, C, De Leòn, FR, Ronfani, L, Room, R, Rosenfeld, LC, Rushton, L, Sacco, RL, Saha, S, Sampson, U, Sanchez-Riera, L, Sanman, E, Schwebel, DC, Scott, JG, Segui-Gomez, M, Shahraz, S, Shepard, DS, Shin, H, Shivakoti, R, Singh, D, Singh, GM, Singh, JA, Singleton, J, Sleet, DA, Sliwa, K, Smith, E, Smith, JL, Stapelberg, NJ, Steer, A, Steiner, T, Stolk, WA, Stovner, LJ, Sudfeld, C, Syed, S, Tamburlini, G, Tavakkoli, M, Taylor, HR, Taylor, JA, Taylor, WJ, Thomas, B, Thomson, WM, Thurston, GD, Tleyjeh, IM, Tonelli, M, Towbin, JA, Truelsen, T, Tsilimbaris, MK, Ubeda, C, Undurraga, EA, van der Werf, M, van Os, J, Vavilala, MS, Venketasubramanian, N, Wang, M, Wang, W, Watt, K, Weatherall, DJ, Weinstock, MA, Weintraub, R, Weisskopf, MG, Weissman, MM, White, RA, Whiteford, H, Wiebe, N, Wiersma, ST, Wilkinson, JD, Williams, HC, Williams, SR, Witt, E, Wolfe, F, Woolf, AD, Wulf, S, Yeh, PH, Zaidi, AK, Zheng, ZJ, Zonies, D, Lopez, AD, AlMazroa, MA, Memish, ZA (2012). Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 2197–2223.Google Scholar
National Institute for Health and Care Excellence (2013). Psychosis and Schizophrenia in Children and Young People: Recognition and Management (CG155) (www.nice.org.uk/guidance/cg155). Accessed 14 August 2014.Google Scholar
Neil, AL, Carr, VJ, Mihalopoulos, C, Mackinnon, A, Lewin, TJ, Morgan, VA (2014 a). What difference a decade? The costs of psychosis in Australia in 2000 and 2010: comparative results from the first and second Australian National Surveys of Psychosis. Australian and New Zealand Journal of Psychiatry 48, 237–248.Google Scholar
Neil, AL, Carr, VJ, Mihalopoulos, C, Mackinnon, A, Morgan, VA (2014 b). Costs of psychosis in 2010: findings from the second Australian National Survey of Psychosis. Australian and New Zealand Journal of Psychiatry 48, 169–182.Google Scholar
Nelson, B, Yuen, HP, Wood, SJ, Lin, A, Spiliotacopoulos, D, Bruxner, A, Broussard, C, Simmons, M, Foley, DL, Brewer, WJ, Francey, SM, Amminger, GP, Thompson, A, McGorry, PD, Yung, AR (2013). Long-term follow-up of a group at ultra high risk (“prodromal”) for psychosis: the PACE 400 Study. JAMA Psychiatry 70, 793–802.Google Scholar
Organization for Economic Co-operation and Development (2014). PPPs and exchange rates (http://stats.oecd.org/Index.aspx?datasetcode=SNA_TABLE4). Accessed 14 August 2014.Google Scholar
Petrou, S, Gray, A (2011). Economic evaluation alongside randomised controlled trials: design, conduct, analysis, and reporting. British Medical Journal 342, d1548.Google Scholar
Phillips, LJ, Cotton, S, Mihalopoulos, C, Shih, S, Yung, AR, Carter, R, McGorry, PD (2009). Cost implications of specific and non-specific treatment for young persons at ultra high risk of developing a first episode of psychosis. Early Intervention in Psychiatry 3, 28–34.Google Scholar
Priebe, S, Huxley, P, Knight, S, Evans, S (1999). Application and results of the Manchester Short Assessment of Quality of Life (MANSA). International Journal of Social Psychiatry 45, 7–12.Google Scholar
Rice, DP, Cooper, BS (1967). The economic value of human life. American Journal of Public Health and the Nation's Health 57, 1954–1966.Google Scholar
Rietdijk, J, Dragt, S, Klaassen, R, Ising, H, Nieman, D, Wunderink, L, Delespaul, P, Cuijpers, P, Linszen, D, van der Gaag, M (2010). A single blind randomized controlled trial of cognitive behavioural therapy in a help-seeking population with an at risk mental state for psychosis: the Dutch Early Detection and Intervention Evaluation (EDIE-NL) trial. Trials 11, 30.Google Scholar
Rijnders, CAT, van den Berg, JFM, Hodiamont, PPG, Nienhuis, FJ, Furer, JW, Mulder, J, Giel, R (2000). Psychometric properties of the Schedules for Clinical Assessment in Neuropsychiatry (SCAN-2.1). Social Psychiatry and Psychiatric Epidemiology 35, 348–352.Google Scholar
Stafford, MR, Jackson, H, Mayo-Wilson, E, Morrison, AP, Kendall, T (2013). Early interventions to prevent psychosis: systematic review and meta-analysis. British Medical Journal 346, f185.Google Scholar
Valmaggia, LR, McCrone, P, Knapp, M, Woolley, JB, Broome, MR, Tabraham, P, Johns, LC, Prescott, C, Bramon, E, Lappin, J, Power, P, McGuire, PK (2009). Economic impact of early intervention in people at high risk of psychosis. Psychological Medicine 39, 1617–1626.Google Scholar
Valmaggia, LR, McGuire, PK, Fusar-Poli, P, Howes, O, McCrone, P (2012). Economic impact of early detection and early intervention of psychosis. Current Pharmaceutical Design 18, 592–595.Google Scholar
Van den Brink, M, van den Hout, WB, Stiggelbout, AM, Putter, H, van de Velde, CJH, Kievit, J (2005). Self-reports of health-care utilization: diary or questionnaire? International Journal of Technology Assessment in Health Care 21, 298–304.Google Scholar
Van der Gaag, M, Nieman, DH, Rietdijk, J, Dragt, S, Ising, HK, Klaassen, RMC, Koeter, M, Cuijpers, P, Wunderink, L, Linszen, DH (2012). Cognitive behavioral therapy for subjects at ultrahigh risk for developing psychosis: a randomized controlled clinical trial. Schizophrenia Bulletin 38, 1180–1188.Google Scholar
Van der Gaag, M, Nieman, D, van den Berg, D (2013 a). CBT for Those at Risk of a First Episode Psychosis: Evidence-Based Psychotherapy for People with an “At Risk Mental State”. Routledge: New York.CrossRefGoogle Scholar
Van der Gaag, M, Smit, F, Bechdolf, A, French, P, Linszen, DH, Yung, AR, McGorry, P, Cuijpers, P (2013 b). Preventing a first episode of psychosis: meta-analysis of randomized controlled prevention trials of 12 month and longer-term follow-ups. Schizophrenia Research 149, 56–62.Google Scholar
Yung, AR, Nelson, B, Stanford, C, Simmons, MB, Cosgrave, EM, Killackey, E, Phillips, LJ, Bechdolf, A, Buckby, J, McGorry, PD (2008). Validation of “prodromal” criteria to detect individuals at ultra high risk of psychosis: 2 year follow-up. Schizophrenia Research 105, 10–17.Google Scholar
Yung, AR, Yuen, HP, McGorry, PD, Phillips, LJ, Kelly, D, Dell'Olio, M, Francey, SM, Cosgrave, EM, Killackey, E, Stanford, C, Godfrey, K, Buckby, J (2005). Mapping the onset of psychosis: the Comprehensive Assessment of At-Risk Mental States. Australian and New Zealand Journal of Psychiatry 39, 964–971.Google Scholar
Zorginstituut Nederland (2014 a). Dutch Health Care Insurance Board (in Dutch) (http://www.medicijnkosten.nl/). Accessed 14 August 2014.Google Scholar
Zorginstituut Nederland (2014 b). Pharmaceutical Compass (in Dutch) (http://www.farmacotherapeutischkompas.nl/). Accessed 14 August 2014.Google Scholar
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