A review of economic evaluations of health care for people at risk of psychosis and for first-episode psychosis

BMC Psychiatry

Nusrat Husain¹  Filippo Varese²  Alison R. Yung³  Rory Byrne⁴  Rachel Upthegrove⁵  Matthew R. Broome⁵  Gemma E. Shields⁶  Linda M. Davies⁶  Deborah Buck⁷  Andrew Thompson⁸ 

[1] Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK;Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK;Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK;Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK;Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK;Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia;Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia;Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK;Institute for Mental Health, University of Birmingham, Birmingham, UK;Birmingham Early Intervention Service, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK;Manchester Centre for Health Economics, Division of Population Health, School of Health Sciences, University of Manchester, Manchester, UK;Manchester Centre for Health Economics, Division of Population Health, School of Health Sciences, University of Manchester, Manchester, UK;Institute of Education, University College London, London, UK;Orygen, The Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia;Division of Mental Health and Wellbeing, University of Warwick, Coventry, UK;

关键词: Psychosis;    Cost-effectiveness;    Cost-utility;    Economic evaluation;    Systematic review;   

DOI  :  10.1186/s12888-022-03769-7

来源: Springer

【 摘 要 】

BackgroundPreventing psychotic disorders and effective treatment in first-episode psychosis are key priorities for the National Institute for Health and Care Excellence. This review assessed the evidence base for the cost-effectiveness of health and social care interventions for people at risk of psychosis and for first-episode psychosis.MethodsElectronic searches were conducted using the PsycINFO, MEDLINE and Embase databases to identify relevant published full economic evaluations published before August 2020. Full-text English-language studies reporting a full economic evaluation of a health or social care intervention aiming to reduce or prevent symptoms in people at risk of psychosis or experiencing first-episode psychosis were included. Screening, data extraction, and critical appraisal were performed using pre-specified criteria and forms based on the NHS Economic Evaluation Database (EED) handbook and Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist for economic evaluations. The protocol was registered on the PROSPERO database (CRD42018108226). Results were summarised qualitatively.ResultsSearching identified 1,628 citations (1,326 following the removal of duplications). After two stages of screening 14 studies met the inclusion criteria and were included in the review. Interventions were varied and included multidisciplinary care, antipsychotic medication, psychological therapy, and assertive outreach. Evidence was limited in the at-risk group with only four identified studies, though all interventions were found to be cost-effective with a high probability (> 80%). A more substantial evidence base was identified for first-episode psychosis (11 studies), with a focus on early intervention (7/11 studies) which again had positive conclusions though with greater uncertainty.ConclusionsStudy findings generally concluded interventions were cost-effective. The evidence for the population who are at-risk of psychosis was limited, and though there were more studies for the population with first-episode psychosis, limitations of the evidence base (including generalisability and heterogeneity across the methods used) affect the certainty of conclusions.

【 授权许可】

CC BY