Cost-effectiveness of comprehensive, integrated care for first episode psychosis in the nimh raise early treatment program

Robert Rosenheck, Douglas Leslie, Kyaw Sint, Haiqun Lin, Delbert G. Robinson, Nina R. Schooler, Kim T. Mueser, David L. Penn, Jean Addington, Mary F. Brunette, Christoph U. Correll, Sue E. Estroff, Patricia Marcy, James Robinson, Joanne Severe, Agnes Rupp, Michael Schoenbaum, John M. Kane

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

This study compares the cost-effectiveness of Navigate (NAV), a comprehensive, multidisciplinary, team-based treatment approach for first episode psychosis (FEP) and usual Community Care (CC) in a cluster randomization trial. Patients at 34 community treatment clinics were randomly assigned to either NAV (N = 223) or CC (N = 181) for 2 years. Effectiveness was measured as a one standard deviation change on the Quality of Life Scale (QLS-SD). Incremental cost effectiveness ratios were evaluated with bootstrap distributions. The Net Health Benefits Approach was used to evaluate the probability that the value of NAV benefits exceeded its costs relative to CC from the perspective of the health care system. The NAV group improved significantly more on the QLS and had higher outpatient mental health and antipsychotic medication costs. The incremental cost-effectiveness ratio was 12 081/QLS-SD, with a .94 probability that NAV was more cost-effective than CC at 40 000/QLS-SD. When converted to monetized Quality Adjusted Life Years, NAV benefits exceeded costs, especially at future generic drug prices.

Original languageEnglish (US)
Pages (from-to)896-906
Number of pages11
JournalSchizophrenia Bulletin
Volume42
Issue number4
DOIs
StatePublished - Jan 1 2016

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Episode of Care
Psychotic Disorders
Cost-Benefit Analysis
Costs and Cost Analysis
Generic Drugs
Therapeutics
Quality-Adjusted Life Years
Insurance Benefits
Random Allocation
Antipsychotic Agents
Mental Health
Outpatients
Quality of Life
Delivery of Health Care

All Science Journal Classification (ASJC) codes

  • Psychiatry and Mental health

Cite this

Rosenheck, Robert ; Leslie, Douglas ; Sint, Kyaw ; Lin, Haiqun ; Robinson, Delbert G. ; Schooler, Nina R. ; Mueser, Kim T. ; Penn, David L. ; Addington, Jean ; Brunette, Mary F. ; Correll, Christoph U. ; Estroff, Sue E. ; Marcy, Patricia ; Robinson, James ; Severe, Joanne ; Rupp, Agnes ; Schoenbaum, Michael ; Kane, John M. / Cost-effectiveness of comprehensive, integrated care for first episode psychosis in the nimh raise early treatment program. In: Schizophrenia Bulletin. 2016 ; Vol. 42, No. 4. pp. 896-906.
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Rosenheck, R, Leslie, D, Sint, K, Lin, H, Robinson, DG, Schooler, NR, Mueser, KT, Penn, DL, Addington, J, Brunette, MF, Correll, CU, Estroff, SE, Marcy, P, Robinson, J, Severe, J, Rupp, A, Schoenbaum, M & Kane, JM 2016, 'Cost-effectiveness of comprehensive, integrated care for first episode psychosis in the nimh raise early treatment program', Schizophrenia Bulletin, vol. 42, no. 4, pp. 896-906. https://doi.org/10.1093/schbul/sbv224

Cost-effectiveness of comprehensive, integrated care for first episode psychosis in the nimh raise early treatment program. / Rosenheck, Robert; Leslie, Douglas; Sint, Kyaw; Lin, Haiqun; Robinson, Delbert G.; Schooler, Nina R.; Mueser, Kim T.; Penn, David L.; Addington, Jean; Brunette, Mary F.; Correll, Christoph U.; Estroff, Sue E.; Marcy, Patricia; Robinson, James; Severe, Joanne; Rupp, Agnes; Schoenbaum, Michael; Kane, John M.

In: Schizophrenia Bulletin, Vol. 42, No. 4, 01.01.2016, p. 896-906.

Research output: Contribution to journalArticle

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AU - Robinson, Delbert G.

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AU - Penn, David L.

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AU - Brunette, Mary F.

AU - Correll, Christoph U.

AU - Estroff, Sue E.

AU - Marcy, Patricia

AU - Robinson, James

AU - Severe, Joanne

AU - Rupp, Agnes

AU - Schoenbaum, Michael

AU - Kane, John M.

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N2 - This study compares the cost-effectiveness of Navigate (NAV), a comprehensive, multidisciplinary, team-based treatment approach for first episode psychosis (FEP) and usual Community Care (CC) in a cluster randomization trial. Patients at 34 community treatment clinics were randomly assigned to either NAV (N = 223) or CC (N = 181) for 2 years. Effectiveness was measured as a one standard deviation change on the Quality of Life Scale (QLS-SD). Incremental cost effectiveness ratios were evaluated with bootstrap distributions. The Net Health Benefits Approach was used to evaluate the probability that the value of NAV benefits exceeded its costs relative to CC from the perspective of the health care system. The NAV group improved significantly more on the QLS and had higher outpatient mental health and antipsychotic medication costs. The incremental cost-effectiveness ratio was 12 081/QLS-SD, with a .94 probability that NAV was more cost-effective than CC at 40 000/QLS-SD. When converted to monetized Quality Adjusted Life Years, NAV benefits exceeded costs, especially at future generic drug prices.

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